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.
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.
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.
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.
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.
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.