Although the first line of defense in treating back pain is often rest, after a few days, most forms of back pain improve rapidly through a physician recommended exercise regimen.

When done in a controlled, gradual, and progressive manner, active back exercises distribute nutrients into the disc space and soft tissues in the back to keep the discs, muscles, ligaments and joints healthy. Consequently, a regular routine of lower back exercises helps patients avoid stiffness and weakness, minimize recurrences of lower back pain, and reduce the severity and duration of possible future episodes of low back pain.

Beyond pain reduction, active forms of back exercises, including stretching, strengthening and lengthening techniques, are almost always necessary to rehabilitate the spine in response to other treatments.

Depending upon the patient’s specific diagnosis and level of pain, the back pain exercises and rehabilitation programs will be very different, so it is important for patients to see a spine specialist trained to develop an individualized program of back exercises and to provide instruction on using the correct form and technique.

  • Exercise should be prescribed by a spine specialist
  • A balanced approach is best
  • Effective regimens target the back, but incorporate the entire body
  • Commonly used exercises are McKenzie exercises and dynamic lumbar stabilization
  • Every routine should include stretching, strengthening and low-impact aerobic exercise

Spinal Injection

Injections comprise another nonsurgical treatment option for low back pain. They are typically considered as an option to treat low back pain after a course of medications and/or physical therapy is completed, but before surgery is considered. Injections can be useful both for providing pain relief and as a diagnostic tool to help identify the source of the patient’s back pain.

For pain relief, injections can be more effective than an oral medication because they deliver medication directly to the location that is generating the pain. Typically, a steroid medication is injected to deliver a powerful anti-inflammatory solution directly to the area that is the source of pain.

Depending on the type of injection, relief may be long term or temporary.

Diagnostically, injections can be used to help determine which structure in the back is generating pain. For example, if a spine specialist can inject a numbing agent into a particular region and the patient feels temporary relief, that helps pinpoint possible sources of the pain.

  • There are many types of spinal injections
  • Injections can be administered as a diagnostic aid, as a permanent treatment, or for ongoing pain relief
  • Generally, spine specialists recommend no more than three steroid injections per year for controlling pain (or fewer depending on effectiveness)
  • Epidural steroid injections should not be performed on patients whose pain is from a tumor or infection, and if suspected, an MRI scan should be done prior to the injection to rule out these conditions

Physical Therapy

Physical therapy is the process of manipulating, stretching and strengthening the body under a practitioner’s care. In general, the goals of back pain exercises and physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.

Physical therapy can also include external treatments to reduce pain, such as applying heat and ice, using ultrasound or iontophoresis, or using targeted electrical stimulation, such as TENS.

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Generally, a patient’s back exercise program should encompass a combination of stretching, strengthening and low-impact aerobic conditioning.

Even patients with a very busy schedule should be able to maintain a moderate back pain exercise regimen that encompasses stretching, strengthening, and aerobic conditioning. These exercises suffice as physical therapy for back pain relief.

  • Back pain that has persisted for longer than two weeks generally benefits from physical therapy
  • Almost every individual who has suffered from low back pain should stretch their hamstring muscles once or twice daily
  • To strengthen the back muscles, 15-20 minutes of dynamic lumbar stabilization or other prescribed exercises should be done every other day.
  • Low impact aerobics (such as walking, bicycling or swimming) should be done for 30-40 minutes three times weekly, on alternate days from the strengthening exercises.


Medication is often the first line of defense in the treatment of back pain. Most spine specialists will advise a combination of both over-the-counter and prescription medications to reduce inflammation and control pain.

Medication is typically administered orally (as a liquid or pill) or as a topical ointment. Some treatments, such as corticosteroids, are injected directly into the spine.

  • Medication is the most common treatment for back pain
  • Over-the-counter pain medications most often used to address back pain are acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs or NSAIDs (Advil)
  • Because acetaminophen and NSAID’s work differently to address the pain, they may be taken at the same time
  • For short periods of time, prescription medications (such as narcotic pain medications or muscle relaxants) may be helpful to alleviate pain or related complications
  • Other classes of drugs (such as antidepressants or anti-seizure medications) can also help modulate the sensation of pain and can be taken on a prolonged basis
  • Always consult your spine specialist prior to taking any medication to make sure you are aware of any risks, side effects and drug interactions
  • You should be especially cautious with medications if you are taking other medications, or have any significant medical conditions (such as diabetes)
  • You should always read the label and package inserts for a complete understanding of risks, side effects, and drug interactions

Soft Collars

Soft collars are foam neck braces that are used to provide support and limit motion to the upper spine. Soft collars also maintain the normal alignment of the spine.

A cervical collar is often used to provide support and limit motion while an injured neck is healing. It also helps keep the normal alignment. Cervical collars can be soft (made of foam) or hard (made of metal or plastic). Because these collars can restrict the movement of your head, you may need help with eating and other activities. The skin under the collar needs to be checked every day to prevent blisters or sores.

  • Designed to restrict movement
  • May be worn continuously or only at night
  • Depending on the collar and frequency of use, you may need help with eating or other activities
  • When worn continuously, be sure to check the skin under the collar daily


Traction is the controlled stretching, lengthening and realignment of the spine. a Using moderate pressure, traction pulls the vertebrae of the spine up and apart, to increase space between them, help relieve direct nerve pressure and reduce stress on the vertebral discs.

Cervical, or upper back traction is a common nonsurgical treatment for a herniated disc in the neck that relieves pain by opening up the cervical foramen to reduce pressure on the compressed nerve roots exiting the spinal canal.

  • Traction must be prescribed by a spine specialist and performed by (or with the detailed, at-home instruction of) a licensed physical therapist
  • Traction can either be applied manually, using the fingers to pull up from the base of the neck, or by spinal traction devices
  • Traction is more useful for neck conditions than for lower back pain.

Steroid Injections

An epidural steroid injection is a minimally invasive procedure that delivers steroids via a needle directly into the epidural space to help reduce inflammation. Inflammation is a common component of many low back conditions and reducing inflammation helps reduce pain.

Steroids inhibit pain by reducing the activity of the immune system to react to inflammation associated with nerve or tissue damage. A typical immune response is the body generating white blood cells and chemicals to protect it against infection and foreign substances such as bacteria and viruses.

An epidural, or spinal steroid injection delivers steroids directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help ‘flush out’ chemicals and substances from around the area that may be a source of inflammation or pain.

The epidural space encircles the dural sac and is filled with fat and small blood vessels. The dural sac surrounds the spinal cord, nerve roots, and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Typically, a solution containing cortisone (steroid) with local anesthetic (lidocaine or bupivacaine), and/or saline is used.

A steroid, or cortisone, is usually injected as an anti-inflammatory agent. Triamcinolone acetonide, Dexamethasone, and Methylprednisolone acetate are commonly used steroids.

  • A common, conservative treatment for reducing inflammation
  • Often used in conjunction with other non-surgical treatments
  • Generally, spine specialists recommend no more than three steroid injections per year for controlling pain (or fewer depending on effectiveness)
  • Epidural steroid injections should not be performed on patients whose pain is from a tumor or infection, and if suspected, an MRI scan should be done prior to the injection to rule out these conditions


Acupuncture is ancient Chinese healing technique that involves the insertion of hair-thin, metallic needles at specific points on the body in an attempt to relieve tension and pain. By inserting needles into specific combinations of 2,000 points on the human body, acupuncture unblocks energy pathways, called meridians, allowing the body to return to its homeostatic flow of energy.

Traditional western medicine reasons that acupuncture works by releasing analgesic chemicals in the brain, including opioid peptides, neurotransmitters and endorphins, that stimulate the central nervous system. These naturally occurring chemicals prompt the brain and spinal cord to produce increased sensation, relaxation and energy.

Acupuncture is thought to help with a variety of health problems, including neck pain and back pain.

  • Recommended only when practiced by licensed acupuncturists
  • Often used to supplement traditional forms of therapy

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