Conservative

Treatment

In the last chapter I showed you nine exercises to help alleviate back pain in four weeks. But you probably don't want to wait four weeks for the pain to subside. I sure wouldn't. The exercises are a long-term program designed to relieve your pain by treating the causes of back pain, rather than the symptoms.

In this chapter I'll look at some of the other conservative, or nonsurgical, treatments for back pain. There is a lot a debate about all these methods. Some healthcare professionals swear by some of these treatments; others denounce the same procedures adamantly, while endorsing still other methods. Almost all the following treatments have some merit and will help with some kinds of back pain. None of them are cure-alls, however. At best, most of these therapies will help to relieve the pain temporarily, but few have any actual curative qualities.

I've said over and over that most back pain is degenerative and can be treated by taking better care of yourselfby watching your posture and exercising. But let me say again that I don't recommend that you try treating your back problem without at least having an examination. Like exercising, a few of the following back-pain treatments are not 100 percent safe.

Four Weeks to a Better Back

Some of these therapies, such as applying heat or cold packs to your back, may seem harmless, and in most instances they probably are. Butif you are not sure what your problem isyou could do more harm than good. If, however, you are sure that your problem is degenerative, many of these procedures, combined with an exercise program, can help you feel better. My advice to you is that you try one or two of the following therapies. Any number of them can help relieve the pain. The bad news is that, then again, they may not do anything. Try the conservative program first, before considering a more drastic solution, such as surgery.

Manipulation

I've chosen to discuss this therapy first because it seems to be one of the most popular and the least understood. Basically, this method involves manipulating the spine to realign the joints of the vertebrae. In theory, this will condition the soft

Chiropractics can help relieve some types of back pain.

Conservative Treatment

tissue of the back and help the muscles to relax. During manipulation, the pain sufferer's head, neck and spine are twisted and sometimes jerked in an attempt at realignment of the vertebrae. This action often causes several cracks and pops up and down the spine. Contrary to what you may think, these noises are not the vertebrae popping back into place, but rather the sound of built up gases around the joints being released.

Of course, the most common practitioners of manipulation are chiropractors. Even though they are not actually licensed physicians, chiropractors are quite popular in the U.S. They do not prescribe medications nor perform surgeries, which does not necessarily mean they are not qualified to treat back pain. Another healthcare profession that employs manipulation is osteopathy. Osteopathic physicians are licensed doctors.

Historically, there has been a lot of controversy around manipulation in the medical world. Many patients swear by it, claiming near miraculous pain relief. Critics of the practice argue that manipulation does nothing that nature doesn't do by itself, or that manipulation actually decreases nature's natural healing process. Still other critiques claim that permanent, more serious injuries can occur, such as the pinching of a nerve or fracturing a disc.

Injuries of this nature are very rare; the risk is very minimal. My feelings are that if a patient is in a lot of pain, and manipulation might help, why not use every thing at our disposal. My one objection to chiropractics is that a few practitioners seem to treat patients longer than necessary. But then this is definitely not to say that manipulation doesn't do anything for back pain.

The real question is whether the therapy treats the cause or the symptoms, and there doesn't seem to be enough conclusive evidence at this point to make that decision.

Bed Rest

As I said in an earlier chapter, bed rest can do some back pain sufferers more harm than good. If your back is hurting because of weak, underdeveloped muscles, lying motionless in

Four Weeks to a Better Back

bed is not going to strengthen them. However, there are times when bed rest is necessary.

If you are suffering from muscle sprain or strain, or if your degenerative problem has become acute, it just might be necessary to take it easy for a little while before embarking on an exercise program. Again I'd like to emphasize the need for an examination. I should say, though, that if your back hurts too much to move around, it probably hurts enough for you to stay in bed for awhile.

There are a couple of problems with bed rest therapy, though. First: Remember when I talked about emotional stress contributing to back pain? Well, if you are an active person, a doer who lives a full, productive life, staying in bed might not be the best thing for your mental state. If the pain isn't too bad, you might be better off at work or taking care of things around the house, rather than lying around. Just take it easy. Second: Bed rest may not work for you. Even though bed rest is one of the oldest and most common therapies for back pain, it doesn't work for a lot of people. In fact, like I said, it has been known to make some sufferers feel worse.

Hot/Cold Therapy

You've probably heard arguments for both heat and cold applications to painful areas. You know, "Heat reduces swelling" or "Ice will help stop the pain." Both will help, and, in the long run, both accomplish the same thing increasing blood flow to the affected areas. Both are effective in relieving the pain brought on by muscle spasm.

Conservation Treatment

Heat causes blood vessels to expand, increasing the flow of blood to the muscle experiencing the spasm, and those surrounding it. The increased blood flow causes the spasm to relax.

Ice packs, on the other hand, achieve the same results by restricting blood vessels so long that they finally fatigue and

Some physicians and chiropractors use ultra sound to apply heat to the back.

Four Weeks to a Better Back

dilate (expand). Blood flow to the affected area is thereby increased.

Which should you use? Most people find heat more comfortable. Although cold, or ice packs, are uncomfortable only for a very short timeuntil the area numbs. Because of the numbing, ice may work somewhat faster than heat. Most likely, deciding which forms to apply and how often to use it are more important questions than which to use.

Cold can be applied in several different ways, although most applications will require ice or a specially made ice pack that you keep in your freezer. Some doctors recommend two to four applications a day. If you are in pain, more applications will not hurt you. Just apply the cold pack to the painful area and relax. Some healthcare professionals use special chemicals to cool down affected areas, products with names like "Liquid Ice." But these products are not any more effective than what you can prepare at home.

There are all kinds of gadgets designed to apply heat to your body's troubled spotselectric hot pads, hot tubs, ultrasound. If you are at home you can use a good old fashioned hot water bottle or a hot towel. If you have a jacuzzi at your disposal, by all means use it. And don't forget to enjoy yourself. Wet-heat seems to work better than dry heat, because of wet-heat's ability to penetrate. So your hot water bottle may work a little better than your heating pad.

In their offices, healthcare professionals use more sophisticated heating devices, such as ultrasound. Ultrasound, which is believed to penetrate deepest into the body, thereby reaching the affected tissues more efficiently, works similar to your microwave oven. The sound vibrations agitate the molecules in your tissues, causing them to produce heat deep down in the affected area.

Drugs

Aspirin is the most widely used drug for treating back pain. But several others, many of them considerably stronger are often prescribed for severe pain. Of course, it is important to

Conservative Treatment

exercise caution when taking drugs for any ailment. Aspirin works well because it not only kills pain but also is an antiinflammatory, which means it reduces inflammation, or the actual irritation and swelling from an injury.

Then, too, there are the newer competing over-the-counter drugsTylenol and anti-inflamatories, such as Ibuprofen. These drugs are also effective in relieving back pain. Each, however, can cause minor problems for certain people, such as, say, stomach irritation. However, if you are old to enough to be reading this book, you probably already know which of these drugs works best for you.

Doctors also treat back pain with muscle relaxants and narcotics (e.g., morphine, Demerol, Codeine, Percodan, etc.) Narcotics and some muscle relaxants (Valium, Flexeril, etc.) are not only intoxicating, but they are also highly addicting. This does not, however, cause me to rule them out as therapy for back pain. Severe pain sometimes calls for drastic treatment. But seldom in cases of degenerative back pain are narcotics necessary. I seldom prescribe either muscle relaxants or narcotics for any kind of back pain. And most reputable physicians do not either.

Massage

Massage, similar to heat and cold therapies, is an almost always harmless means of relieving pain. It involves little or no risk, depending on the expertise of the masseuse. Not only does massage relieve pain for many back pain sufferers, but it is also very relaxing. Many people get massages regularly to help relieve tension in the muscles brought on from everyday

Four Weeks to a Better Back

stressors. Also, like heat and cold treatments, massage works by opening the blood flow to the affected area. Although it has not been proven that massage speeds up the healing process, it can certainly help ease the pain while nature takes its course.

Traction

As we saw in the chapter on the history of back pain, tractionstretching the spinehas been around for a long time. The Chinese have been pulling on sore backs for thousands of years. Nowadays we have all kinds of gadgets to pull on your body. You've surely seen all those funny scenes in movies where legs and arms are elevated with a series of weights and pulleys. Well, traction devices for the back are similar. While in traction for back pain, weights pull on both the lower and upper halves of your body.

The theory behind traction is that the pulling relieves the pressure on the vertebrae and nerves in the spine. It is also believed that traction will work similar to manipulation to help realign the joints.

The benefits of traction are questionable. The relief is temporary at best, and, like manipulation, once the traction treatments are ceased, the back will probably return to its prior condition especially if you are not taking corrective measures in the form of practicing proper posture and exercise.

Not long ago a wave of inverted traction devises hit the market, the most popular being inversion boots. There has been a lot of discussion in the medical world about the benefits of these devices. Some healthcare professionals claim that they can cause microscopic bleeding in the eyes and brain. As far as I can tell, there seems to be no particular benefit in hanging up-side-down by your feet.

An exception, however, is cervical traction. There does seem to be some evidence that using traction to stretch and stabilize the neck slightly can relieve certain type of neck problems, such as sprains and strains.

Conservative Treatment

Braces

Like traction, support devices, such as braces, corsets, collars, etc. have been around for centuries. The idea behind these devices is that they are supposed to lend support to the spine. Even though some patients and even a few doctors swear by these gadgets, I question their effectiveness.

There may be some usefulness to using a brace designed to compress the abdomen area to support the lumbar region of the spine, but rarely do these devices relieve the pressure from a bulging disc, providing a bulging disc is the problem. My advice concerning the use of a corset or brace is consult your healthcare professional and try some of these other conservative treatments first.

An exception, of course, is the neck brace (often called collars) used to stabilize the neck after neck injuries. You've seen these. They are those extremely uncomfortable-looking white contraptions that wrap around the neck. They contain a dip, or curve, in the front for the chin and restrict movement of the head and neck. These can be useful, often critical, to treating neck injuries or in aiding in recovery from neck surgery.

Other Conservative Treatments

Since the following therapies involve invasion of the body with needles and/or fluids, they cannot actually be considered conservative treatments. When compared to surgery, however, none of these methods are nearly as drastic. But each has a degree of risk.

Acupuncture

It wasn't all that long ago that acupuncture was all but unheard of in the U.S. The ancient Chinese practice has evolved from 5,000 years of Chinese culture and history. Acupuncture is the practice of inserting long, thin needles at certain strategic points along the body. The placement of the needles is based on important energy lines that run through the body. Acupuncture has been known to help some back pain sufferers, but like

Four Weeks to a Better Back

all other treatments, it is not the answer to everybody's problems.

Acupuncture is also sometimes used to alleviate stress, which can do nothing but good things for your back.

Cortisone, Novocaine and Other Injections

If you've ever been to the dentist you're familiar with novocaine. As you can imagine, the effects of these anesthetics is similar no matter where you inject them. You still wind up with that fat, numb feeling. The problem with this type of invasion therapies is that they often involve deep injections that can be painful, and, if not administered properly, hazardous. One thing is certain, none of these drugs do anything to speed up healing, and it has been found that they are no more effective than most other more conservative treatments for relieving pain.

Chemonucleolysis

Try saying that fast six times, or even once. This is an alternative to surgery for bulging discs. It involves injecting an enzyme directly into the disc itself to dissolve the soft jellylike center. As you can imagine, dissolving the nucleus of the disc will make the disc itself smaller, thereby relieving pressure on the spinal cord or nerves. The entire procedure takes about an hour and usually requires a few days of hospitalization. Chemonucleolysis is sometimes preferable to open surgery, but it is certainly not risk-free. There have been cases where serious allergic reactionseven deathhave resulted from the enzyme. However, the success rate for this method is relatively high.

Epidural Steroid Spinal Injections
and Trigger Point Injections

This treatment involves injecting an anesthetic such as novocaine with cortizone or steroid-like medicine into the spinal epidural space or points in the back that are believed to be linked to spinal pain. It appears that often this type of therapy

Conservative Treatment

Ancient acupuncture diagram.

Four Weeks to a Better Back

is beneficial. The results are varied. I am inclined to use other treatments before injection treatment.

Psychological Treatments

Since not only your back pain, but your entire health can depend so greatly on your emotional well-being. But that is what this book is aboutmaking yourself feel better about your back.

Ancient acupuncture diagram.