Millions of people around the world suffer from low back pain (LBP), both acute, and chronic. What often starts off as an acute injury can quickly turn into a chronic condition that continues to flare up throughout people’s lifetimes. With around 80% of people in the US experiencing low back pain at some point during their lives, it is no wonder then that chronic low back pain is one of the most common musculo-skeletal disorders.
While some cases are caused by injury or trauma, oftentimes there is no particular incident that leads to low back pain and, even when diagnostic imaging tests are done, no specific reason can be found. When no specific reason for the pain can be found, no specific treatment is recommended, and this leaves many patients left on their own to search for alternative ways to treat low back pain themselves.
International and local guidelines often provide the same recommendations when it comes to treating low back pain, with exercise as one of the main treatment options listed. Other therapies can include mindfulness, yoga, EMG feedback, cognitive behavioral therapy and spinal manipulation.
Unfortunately, due to the very nature of pain, there is rarely a one-size-fits-all solution to pain. Some treatment options may work for a while and then seem to stop (see our blog post on TENS units). But one thing is apparent, the chronic nature of LBP means that many people are eager to try treatments that do not involve medication. Fortunately, as the research on low back pain continues to grow, so do people’s options for treatment. In this blog we take a brief look at some of the different alternative treatments for low back pain patients and see how they work.
Alternative Treatments for LBP
Patients suffering from most common types of low back pain are often referred to a physical therapist for treatment. Typically, as an initial non-surgical treatment option, physical therapy takes place for around four to 8 weeks. This is a conservative approach that doctors prefer to try before considering more aggressive and expensive treatments like surgery. Physical therapy aims to decrease pain, increase mobility and functioning, and help the patient develop tools and techniques to prevent future low back pain problems.
Common forms of physical therapy include:
Passive physical therapy: heat application, ice packs and electrical stimulation.
Active physical therapy: specific exercises and stretching of muscles.
Research has shown that myofascial release treatment, in combination with deep breathing training, led to greater improvements than traditional conventional care for low back pain under almost all measures. When patients engage in deep breathing, the science seems to indicate that the muscle tone is relaxed and myofascial release is improved.
Mindfulness is a type of meditation in which you focus on being intensely aware of what you’re sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.
When it comes to chronic low back pain, mindfulness has been shown to decrease negative emotions (such as fear of pain) related to chronic pain. Over time, many patients have developed a different perspective when dealing with their pain. Several ways that mindfulness impacts older adults with chronic LBP include: decreased negative emotions related to chronic pain (such as fear of pain); a different perspective, or change in awareness, about pain; and reduced significance of pain.
Meditation is the practice of observing your feelings and thoughts from a distance, with no judgement. Meditation allows you to acknowledge where your mind is at any particular point in time, and simply letting your mind wander, without judging the thoughts that arise. Recent studies have shown that a combination of meditation and CBT can actually work better than pain medication.
Inflammation is where your body develops a physical response to an injury or infection. If left unchecked, inflammation can run rampant throughout your body and can cause many different chronic issues, including low back pain. One of the best ways of addressing inflammation is through diet. Creating a diet that is rich in anti-inflammatory foods can help you maintain good nutrition and can actually reverse some chronic conditions like heart disease.
Anti-inflammatory diets tend to be mostly plant-based and can include things like turmeric, flaxseed, chia seeds, and fish that are rich in Omega-3s. Berries are also a core component of an anti-inflammatory diet and the rule of thumb is “the darker the berry, the higher the anti-oxidant”. Beets, blackberries, blueberries, cherries, pomegranate, and watermelon are all key fruits that can reduce inflammation.
When it comes to vegetables, the greener the vegetable, the better. Kale, broccoli, and spinach are great leafy vegetables to eat. Garlic, ginger, turmeric, and curcumin are herbs and spices that can be added to food for an extra inflammatory boost. If you would like more information on how an anti-inflammatory diet can help see our blog on 'How Your Diet Affects Low Back Pain'.
Acupuncture is a treatment where a series of very thin needles is inserted into your skin at different strategic parts of your body. These needles are then “activated” through gentle movements of the practitioner’s hands or else via electrical stimulation. The idea behind acupuncture is to create an energy pathway (or flow), a Qi, that can improve health.
Studies using functional MRIs have shown the activation of specific regions of the brain when acupuncture is performed. A review of more than 35 clinical trials on acupuncture concluded that acupuncture may be useful as either a unique therapy for chronic low back pain, or as an add on to other treatments for low back pain. Although the pain reduction is often not immediately obvious, the uses for chronic pain seem to be more effective.
Massage therapy involves the physical manipulation of the soft tissues in your body using pressure and movement. Massage therapy can provide substantial pain relief and healing for many lower back problems. When the correct muscle is targeted, the pain can be controlled at its source — for quicker, longer lasting relief. This is particularly effective in low back strains.
Arnica & Essential oils
Essential oils are oils that are extracted from plants. These oils are used in the practice of aromatherapy. It is thought that essential oils can impact the body’s limbic system, a part of your brain that controls unconscious physiological functions such as breathing, heart rate and blood pressure.
While there is not a lot of scientific evidence surrounding the use of essential oils, some oils, like arnica, have been used to treat pain, particularly sprains and bruising. Typically this oil is applied to the affected area and is massaged into the skin.
Heat and Cold Therapy
Heat therapy is often used in the course of physical therapy but it can also be done in an at-home setting. Heat (and cold) therapy is a cost effective and easy to use remedy for back pain because it boosts circulation, which allows nutrients and oxygen to travel to joints and muscles. This circulation helps relieve inflammation, repairs damaged muscles, and improves back stiffness.
Low back pain is intrinsically tied to issues surrounding the structure of the spine and the intervertebral discs. The spine is also wrapped by muscles that support it. Repetitive stress in spinal ligaments and joints, and accompanying stress on the muscles surrounding and supporting the spine, can lead to chronic pain and inflammation. The stress and injury to the muscles and discs often lead to people being afraid to move, so they end up resting too much or decreasing their activities and movements. Sadly, this only leads to more inflammation and to more pain.
Myofascial release and stretching that is done in settings such as with massage therapists, physical therapy practices, or with chiropractors. It can help to reverse these abnormalities and can restore functioning, enabling patients to start moving again. Some stretching exercises can be done in a home setting, for little to no financial cost.
As we mentioned previously, the spine is supported by a framework of muscles that protect the spine and hold it up. Exercise is a highly effective way to increase strength in those supporting muscles, which in turn provides better support for the spine, as well as removing pressure from spinal discs and joints.
Aerobic fitness is an effective way to improve circulation which allows for the distribution of nutrients throughout the body. Exercise also generates endorphins, which naturally relieve pain. As such, any exercise program that combines aerobic fitness, flexibility and muscular strength is immensely beneficial for improving chronic low back pain.
While more research is needed in this area, there is a growing body of evidence that suggests that Pilates is beneficial for those suffering from chronic low back pain. Pilates is a type of exercise consisting of low-impact flexibility and muscular strength and endurance movements. Named after its creator, Joseph Pilates, Pilates emphasizes proper postural alignment, muscle balance and core strength.
Pilates is an effective way of toning muscles, helping improve poor posture, and improving flexibility. Movements often focus on learning how to hold a neutral spine alignment, and strengthening the deep postural muscles that support the spine. In Pilates, core strength is key. For patients who suffer from pain caused by the degeneration of the intervertebral discs, Pilates is an excellent program for rehabilitation.
Yoga is the practice of physical exercise, breath control, relaxation and meditation. More than just a physical workout, yoga is a full mind and body practice. The relaxation techniques incorporated in yoga can lessen chronic pain, such as lower back pain. The appropriate poses done in a yoga class can both relax and strengthen your body. No matter what your fitness level is, yoga has something for everyone. Practicing yoga for just a few minutes a day can help with tension release, and can improve balance, strength, and alignment. Yoga is a great way to build spinal flexibility and improve mobility.
Biofeedback is a technique that helps you learn how to control some of the functions of your body, such as heart rate. During biofeedback, you’re connected to special electrical sensors that help you receive information about your body. The feedback received helps you make subtle changes in your body, such as relaxing certain muscles, to achieve results like pain reduction. One common type of biofeedback is the use of surface electromyography (sEMG).
SEMG biofeedback assesses one or more muscles and provides real-time feedback to both patients and physical therapists on whether the correct muscle groups are being activated or relaxed. It can also provide information on the precise levels, or intensity of activation. This information is then used to avoid injuries by making sure that when patients learn new movements, they execute the movement in the correct way. Recent studies on EMG devices have been investigated with promising results.
Getting a good night’s sleep is not just a luxury — it is a biological necessity. When we sleep, the body enters deep non-REM and REM sleep stages which are crucial for healing and repairing our bodies. During these sleep phases, restorative chemicals (like growth hormones) are activated. The release of growth hormones are necessary for simulating cell regeneration, cell repair, and cell reproduction. High quality, restorative sleep enables essential healing processes to take place and the spine and other cells are able to repair overnight.
During spinal manipulation, practitioners use their hands, or a device, to apply a controlled thrust (or force) to a joining of your spine. Spinal manipulation is generally performed by a licensed chiropractor. Specific manipulation techniques have been developed with the aim of stretching or manually massaging the spinal muscles in an attempt to relax them.
Some of the best results from spinal manipulation have been reported in patients where a diagnosis of Sacroiliac Syndrome has been made. Studies have shown that more than 90% of patients with this diagnosis have shown improvement in their back pain following manipulation.
These are just some of the most popular alternative treatments for chronic low back pain. There may be some that you have heard of and others that you are less familiar with. Some of these treatments have quite a bit of data to show their long term effectiveness, while others are still trying to gather sufficient data to support their use.
One thing to keep in mind when considering trying out a new treatment, is to consult with your healthcare provider and make sure that the new treatment will not conflict with any current treatments that you are receiving. For example, while essential oils are considered to be “natural” they can have some real pharmacological results. Arnica can act as a blood thinner and should not be taken when you are about to undergo surgery.
You should always tell your doctor about any supplements you are taking, or treatments you are undergoing, in order to reduce the possibility of any medical complications. Your doctor will also be able to discuss with you the recommendations according to global guidelines and together you can explore which treatments might fall in line with a personalized, recommended treatment plan.
What is exciting to see is that, as recognition of the massive impact that low back pain has on quality of life increases, more and more solutions are becoming available for the treatment of this debilitating condition. We hope to see more solutions emerge with the science to support it. With modern technological advances, the sky’s the limit.
We would love to hear from you! If you have an experience with a particular treatment that you would like to share with us, feel free to comment below or tag us on social media. Don’t forget to subscribe to our blogs so you don’t miss out on any of the topics that we will be covering in 2021!