Spinal manipulation is a therapy offered by chiropractors, osteopaths, and physical therapists. Physical leverage is combined with a series of exercises to adjust the spine and restore back mobility, while easing pain. Traditional massage is often used with spinal manipulation.
Physical therapy includes exercises, teaching back care principles, and using heat, ice, and other methods to relieve pain.
The purpose of physical therapy is to reduce the pain, strengthen the muscles, increase motion and function, and prevent future injury. Physical therapy should include a home exercise program. Treatments may include:
- Cold packs, which are usually used in the beginning to help reduce pain and muscle spasms
- Heat, which is used to relieve pain and muscle stiffness
- Aerobic exercises such as walking or swimming
- Stretching exercises
- Percutaneous nerve stimulation (PENS)
- Braces or other physical supports
Biofeedback teaches people how to control body functions they normally do not think about. It may help you reduce the severity of the pain. A biofeedback therapist will guide you to relax certain muscles or control breathing. A device shows your body’s response.
Relaxing the muscles can help prevent and reduce the severity of muscle tension and back pain. Relaxation techniques may include conscious breathing, visualizing being in a relaxing place, or clearing the mind of any thoughts. A mental health professional can teach you how to perform different relaxation techniques.
Cognitive-behavioral therapy (CBT) is often used to help manage chronic pain and stress. It is a form of talk therapy that may be done individually or in a group. A therapist will help you identify negative thoughts and teach you to unlearn these thought patterns. You will also learn new, helpful habits to manage your pain with minimal disruption to your life.
Epidural Injections and Joint or Soft Tissue Injections
A steroid medication is injected into the epidural space in the spinal canal to decrease inflammation. Injections can be repeated if necessary. Other targets for injection include the facet and sacroiliac joints, as well as muscles and other soft tissues.
Consult your physician about what exercises may be helpful for lower back pain. While there is mixed medical evidence about just which exercises will strengthen the back, specialists agree that it's important to keep moving. Low-impact activities like swimming, bicycling, and walking are especially recommended. Properly performed abdominal crunches and flexibility exercises are also important for strengthening the stomach muscles and relieving tight back muscles.
When to Contact Your Doctor
More serious symptoms associated with back pain that may require immediate medical attention include:
- Pain that does not subside or worsens with rest
- Pain that is worse when you are reclined
- Pain that is severe or that has gotten worse
- Progressive weakness or numbness in a leg or foot
- Difficulty walking, standing, or moving
- Numbness in the genital or rectal area
- Loss of bowel or bladder control
- Burning or difficulty with urination
- Fever, unexplained weight loss, or other signs of illness
2008 physical activity guidelines for Americans. US Department of Health and Human Services. https://health.gov/paguidelines/guidelines/chapter1.aspx. Accessed December 27, 2017.
Acupuncture and related therapies for chronic low back pain. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T906249/Acupuncture-and-related-therapies-for-chronic-low-back-pain. Updated August 11, 2016. Accessed December 27, 2017.
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Chronic low back pain. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain. Updated June 30, 2017. Accessed December 27, 2017.
Counseling and education for chronic low back pain. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T910282/Counseling-and-education-for-chronic-low-back-pain. Updated December 22, 2017. Accessed December 27, 2017.
Exercise therapy for chronic low back pain. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T906250/Exercise-therapy-for-chronic-low-back-pain. Updated November 27, 2017. Accessed December 27, 2017.
Manual therapies for chronic low back pain. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T910280/Manual-therapies-for-chronic-low-back-pain. Updated June 30, 2015. Accessed December 27, 2017.
Physical supports for chronic low back pain. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T910281/Physical-supports-for-chronic-low-back-pain. Updated June 30, 2015. Accessed December 27, 2017.
Sciatica. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115166/Sciatica. Updated May 8, 2017. Accessed December 27, 2017.
Thermal and electromagnetic therapies for chronic low back pain. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T906118/Thermal-and-electromagnetic-therapies-for-chronic-low-back-pain. Updated March 23, 2015. Accessed December 27, 2017.
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5/23/2017 DynaMed Plus Systematic Literature Surveillancehttps://www.dynamed.com/topics/dmp~AN~T115166/Sciatica: National Guideline Centre. Low back pain and sciatica in over 16s: assessment and management. London (UK): National Institute for Health and Care Excellence (NICE); 2016 Nov.
Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 5/23/2017