Chiropractic Therapy

One of the most common physical treatments for back pain is chiropractic therapy, which is the manipulation of the spine. The purpose is to realign the spine, increase the range of motion in the muscles of the back, increase the flexibility of spinal soft tissue, break down scar tissue, and reduce pressure that occurs from restricted and misaligned spinal joints, all of which help to relieve pain. Chiropractic therapists, which include not only chiropractors, but also osteopaths and some physical therapists, diagnose and treat only problems with the muscles, nerves, and skeletal system and do not use drugs or surgery. Going to a chiropractor is much like going to a regular doctor: you will be asked for a case history involving your symptoms, have a physical exam, and possibly have x-rays taken.

Chiropractors undergo intense medical training. They must have two years of undergraduate work, and when they enter chiropractic college, they study the same topics doctors do, including anatomy, physiology, x-ray, psychology, and orthopedics. After getting the basics down, chiropractors then study diagnosis and adjustment techniques that most other doctors do not. Besides their coursework, chiropractors also have intern and externships, where they observe and assist licensed chiropractors. All in all, chiropractors spend about 900 hours studying and working in their field. After graduation, chiropractors must either take a test to be licensed in the state in which they want to practice or the National Board of Chiropractic Examination.

Osteopaths are medical doctors and can prescribe medications. They must have an undergraduate degree and take the Medical College Admissions Test before being admitted to osteopathic medical school. Like other doctors, osteopaths take four years of coursework and spend time observing in medical settings. They do internships and sometimes residencies, and must take exams in order to be licensed.

Studies have shown that chiropractic manipulation is effective in treating lower back pain. However, it has not been shown to be any more effective than any other method of treatment, but has been shown to be better than no treatment at all.

Chiropractic treatment is most effective when applied within two months of the onset of lower back pain, but probably will not help people who have disc prolapsed, previous back surgery, or back pain due to disease. If you decide to consult a chiropractor, make sure you tell him about any serious back injuries you have had, and any sharp pain or lower back pain with leg pain or numbness. These could be the signs of serious conditions that could be worsened by spinal manipulations.

If you are interested in chiropractic treatment, meet with the chiropractor in person to get a feel for the kind of treatment he offers, and look for someone who diagnoses with a physical exam. While x-rays are occasionally taken, they should not be the only diagnostic tool used. Ask about what kind of manipulations the doctor or therapist generally does and look for someone who uses primarily slow, gentle motions rather than sharp and sudden jolts. Avoid anyone who wants to crack your neck, as this can be very dangerous.

When you go for treatment, you will lie on your side or stomach while the therapist does various manipulations. He may put one hand on your shoulder and one on your hip and gently twist your body, or he may put pressure on the spinal joints. When this is done, you may or may not hear a crack. Chiropractors may also use ultrasound, therapeutic massage, stretching, and muscle stimulation to help relieve back pain. You may have some soreness for a day or two after treatment.

Studies have shown that you should feel relief from pain in four to eight sessions. While some chiropractors may suggest a longer course of treatment, there is no evidence that it will be more effective. If you don’t feel better in four to eight sessions, chiropractic treatment probably won’t help you.

There are few risks involved with gentle manipulations, but there are some serious ones that can occur in certain situations. People with osteoarthritis should avoid twisting manipulations as this can cause bone spurs to damage the spinal cord and nerves. Although it is rare, there have been cases where forceful neck manipulations have resulted in neurological damage and death. It’s best to avoid spinal manipulations if you have osteoporosis or nerve damage. Check with your doctor if you’ve had spinal surgery, or back pain along with fever, chills, sweats, or unintentional weight loss. Chiropractic therapy won’t help you if you have back pain due to infection or tumor. And finally, rapid neck manipulations can lead to strokes. You can avoid risks by giving your therapist a thorough account of all injuries and illness you’ve had.

A good chiropractor is one who is willing to work with your other medial professionals. She should also give you self-care information and exercises to do at home. Avoid anyone who wants you to continue sessions to prevent future back pain; studies do not show this to be effective.

Physical Treatments

Unless back pain is due to an infection, malformation of the back, or tumor, your pain can probably be alleviated by some type of physical treatment. All physical treatments are more effective when done in combination with other treatments. It is best if you can get a referral from your doctor for physical treatment, and many insurance companies require you to do so before they will pay for treatment. The effectiveness of the various physical treatments varies, and it’s really up to you as to which you are most comfortable with. The effectiveness of physical treatments is increased when they are combined with exercise.

Homeopathy

Homeopathy is a practice of medicine that has been around for about 200 years. It is based upon what is called the Law of Similars and works on the same principle as do immunizations: give someone a small dose of what would make them sick to cure their sickness. Treatments have been proven in clinical trials, and are prepared by a homeopathic pharmacy under FDA guidelines. Researchers don’t completely understand how homeopathic medicines work, but the evidence is clear that they do. Homeopathy has been popular in Europe and India for a long time, and is gaining popularity in the United States. Many practitioners are doctors or have some other kind of medical degree, perhaps in nursing or psychology. The legal issues surrounding homeopathic practitioners that do not have medical degrees is unclear, but most homeopathic remedies are sold over the counter and do not need a prescription.

Here are some natural homeopathic remedies that are helpful in alleviating back pain:

• Aesculus: used for dull, nagging pain
• Arnica Montana: used in cases of trauma to the back
• Colocynthis: used for weakness and muscle cramps in the lower back
• Gnaphalium: used to treat sciatica, which is often associated with back pain
• Lycopodium: used to treat burning pain
• Rhus Toxicodendron: used for lower back stiffness and pain

Herbs

Herbal supplements can be found in capsule or powder form, or as teas. If you are making your own herbal tea, use 1 tsp. of herb per cup of hot water. Cover mixture and steep for 5-10 minutes, or 10-20 if you are using roots. You can safely drink 3-6 cups of tea daily.

Muscle Relaxants

• KAVA KAVA: Recognized by some doctors as a safe alternative to Xanax and Valium.
• BLACK HAW: relieves muscle spasms and is similar to aspirin
• VALERIAN ROOT: Widely researched and documented as a sleep aid, valerian has been given a number 1 rating for safety by The American Herbal Products Association.
• WILD YAM: Long used to treat menstrual cramps; generally taken as a tea.
• JAMAICA DOGWOOD: Used to treat muscle inflammation and spasms; little research has been done on it and excessive amounts can be toxic. Do not use with sedatives.

Anti-inflammatories

• BROMELAIN: 500 mg three times daily
• BOSWELLIN: 150 mg three times daily. Has been proven in clinical trials to help alleviate low back pain
• CURCUMIN: 400-600 mg three times daily; sometimes mixed with ginger, curcumin has not been studied in clinical trials, but herbalists use it as an anti-inflammatory.
• MSM: Has not been researched, but herbalists use it as an anti-inflammatory.
• ST. JOHN’S WORT: 300-500 mg capsule three times daily; interacts with a wide variety of medications and should only be taken under the advisement of an herbal specialist.

Pain Relief

• WHITE WILLOW BARK: effects are similar to taking aspirin
• DEVIL’S CLAW: 400 mg three times daily. Used to treat arthritis, research shows devil’s claw may boost the effectiveness of conventional drugs.

Vitamins and Minerals

• VITAMIN E-400 IU daily; anti-inflammatory
• VITAMIN C-250-500mg twice daily
• ZINC-30 mg twice daily; anti-inflammatory
• CALCIUM-600mg daily; strengthens bones
• BORON: 1-3 mg daily with food; helps the body absorb calcium and magnesium
• MAGNESIUM- 250 mg daily; strengthens bones and relaxes muscles
• COPPER: 2 mg daily
• GLUCOSAMINE SULFATE: 500 mg. three times daily. Can rebuild cartilage in joints and has been studied by the American College of Rheumatology as an effective treatment for rheumatoid arthritis.
• NIACINAMIDE: 500 mg three times daily; anti-inflammatory and heals damaged cartilage. Can cause liver damage and aggravate diabetes, low blood pressure, ulcers, and glaucoma, so have a doctor monitor you if you take this supplement.

Natural Supplement Treatment

There are a number of different ways you can treat your back pain naturally: vitamins, minerals, herbs, nutrition, and homeopathy medicine. Some will help heal your back pain and others are dangerous, so it’s best to consult with a physician or nurse practitioner before taking anything and never, ever exceed recommended dosages. The FDA has no control over natural supplements, so it does not recommend them. Since supplements are not FDA approved they must be accompanied by a two-part disclaimer on the product label: that the statement has not been evaluated by FDA and that the product is not intended to "diagnose, treat, cure or prevent any disease."

That doesn’t mean, though, that all supplements are bad. Some medications turn out to be unsafe, too, despite rigorous trials and testing. The bottom line is to research every product you consider taking and make sure you get supplements from a reputable source, like a health food store. Everybody’s chemistry is different and reacts differently, so if you are considering taking a supplement equivalent to a pharmaceutical, you may still have some side effects.

There are many natural supplements that can be found in supermarkets and drug stores. You may have to check health food stores for more obscure supplements. Like any kind of medication that you buy over the counter, you’ll have a choice between the store brand and name brands. Store brands are perfectly safe to use and are less expensive because you don’t have to pay for advertising. You can also buy supplements over the internet, but you should be sure you buy from a reputable source so you know exactly what you are getting. Do some research and ask around to find out which online suppliers are the best and most reputable.

Listed below are some natural supplement treatments that have been publicized to help alleviate back pain. When dosages are listed, you should know that if you are particularly thin or heavy, you should consult an expert before taking the supplement. And remember, natural supplements will not relieve pain immediately, but have to be taken for weeks or sometimes even months before you see results.

Treatment Overview

The main relief treatment for chronic low back pain is conservative intervention. In other words, jumping into surgery is not advised because many people suffer no back pain yet have degenerative change or aging issues going on in the back region. And other treatment options may offer relief instead. And according to studies, there is no evidence that points to delayed surgery resulting in increased complications. In fact approximately 80 percent of the cases where surgery was indicated as a solution recovered regardless of the surgery. So whether or not they had it made no difference. Really under 40 percent are reported to have benefited from surgery. And on the contrary, those people with surgical pasts reported the need for future surgeries, many because their pain actually increased with surgery. So good medical history and physical examination preparation and assessment can go a long way in determining treatment options.

Conservative treatment would include an overall physical and psychological pain-handling program incorporated into the patient’s lifestyle. It would education and offer training about symptom management; movement and posture strategies, physical therapy, acupuncture, epidural analgesics, pain medication and other associated issues.

Where To Go for Pain Relief?

Where to go for a diagnosis about back pain can include your family doctor, the emergency room, an orthopedic surgeon, a naturopathic specialist, a rheumatologist , an occupational therapist, a physiotherapist, a chiropractor, an acupuncturist, a massage therapist, an osteopath and a chronic pain heath care provider. And here is a brief overview of each.

FAMILY DOCTOR – This is a popular beginning point for many seeking back pain relief. Although family doctors generally do not have extensive orthopedic backgrounds nor sufficient time to schedule complete histories and examinations during regular hectic weekdays, they are often able to do preliminary testing and assessment. Their blood tests and general knowledge of your health and basic back care can help them point you to further resources and places for following up, especially if they deem the case an emergency. And hopefully your family doctor will be at the center or helm of your pain relief management so that all testing, treatments, office visits, etc. are coordinated and not left to chance, and also so that patient care is optimized.

EMERGENCY ROOM – When a family or general doctor is not available, some symptoms may warrant an emergency room visit. The following list of symptoms, though not limited, is what most often sends people to the emergency room for back pain relief; a major injury or trauma, history of osteoporosis, steroid medications or cancer, severe pain, fever, aggressive or quick weight loss for no known reason. The degree of suggested seriousness in the symptoms may determine how quickly a person is seen in the emergency room, with the more serious cases seen quicker.

Emergency room procedures can involve history and examination assessments and a series of blood, urine and other tests. Additionally the emergency room physician may recommend a consult with a specialist while you are there. Or they may recommend you to your family doctor or other treatment facility for follow up, depending upon their results.

ORTHOPEDIC SURGEON – Orthopedic medicine in a nutshell deals with the prevention or correction of injuries or disorders of the skeletal system and associated muscles, joints, tendons and ligaments. Surgeons in this field offer treatment for fractures, strains, arthritis, dislocations and other related problems throughout the entire body. And their treatments vary with surgery and non-surgical health care; structure repair, joint replacement, arthroscopy or the examination and possible treatment of the interior of a joint, like the knee, using a type of endoscope inserted into the joint through a small incision. Likewise, they coordinate healing activities during healing and pain relief stages. Note that some orthopedic surgeons specialize: in the area of back pain relief, a specialist based in spinal practice may be advisable.

NATUROPATHIC SPECIALIST – Naturopathic medicine refers to natural substances or remedies massage as treatments. Doctors in this field are educated in nutrition and herbal, botanical, homeopathic and Chinese medicines (and acupuncture). They may also treat with hands-on procedures and lifestyle consultations where preventative measures are a focus. These specialists may refer you to your family doctor and may also coordinate healthcare activities before, during and after your back pain episode for overall improved wellness. Often for back pain relief, they may advise natural supplements like herbal medicines or minerals along with dietary modifications. And physical therapy; acupuncture or message, combined with stress management and relaxation therapy may be added in for good measure.

RHEUMATOLOGIST – A rheumatologist deals with an array of pathological conditions like arthritis related to the tendons, muscles, joints, nerves or bones, when seeking aid for discomfort and disability. Although some may perform arthroscopy, most do not do surgery. For back pain relief, they may suggest medications, occupational or injection therapy and other medical treatment to determine cause and pain relief.

OCCUPATIONAL THERAPIST – An occupational therapist emphasizes correct ergonomics or design factors, posture and safety practices both at the workplace and in the home environment. These therapists educate patients about daily life activities and can help with adjusting to health devices for mobility and operation. Adjusting to using crutches, a back brace, a cane and other lifestyle changes are benefits of occupational therapy.

PHYSIOTHERAPIST – Registered therapists practice physiotherapy and focus on educating and instructing patients about their pain- both in book learning and physical understanding, like with posture and movement modifications. Their shared knowledge helps patients overcome fear and anxiety and better manage their treatment programs. Doctors often refer patients to physiotherapists for extended learning, particularly if there is difficulty in diagnosing the cause and / or treatment for pain. Additionally, physiotherapists help with the development and managing of their healthcare programs, activities and preventive care instruction. For example, they may teach about using heat or ice along with a varied range of motion for pain relief.

CHIROPRACTOR – In a nutshell, chiropractors diagnose spine, joint and muscle problems with their hands. And their treatment is hands-on as well. For back pain relief, they use mobilizations and manipulations in manual spinal movements, some known as “cracking” the back into place. Although there is no scientific evidence to support or negate chiropractors treatment, most generally work with the relief of acute low back pain. Besides in-office treatment, many provide exercise and preventative strategies for follow up.

ACUPUNCTURIST – Acupuncture, relating to Chinese medical practice, is the piercing of specific areas of the body with fine needles. The reasons for acupuncture are threefold; for therapeutic purposes, to relieve pain or for regional anesthesia. It is mainly used for musculoskeletal pain and low back pain and other related relief.

MASSAGE THERAPIST – Massage therapy incorporates hands-on handling or manipulation of body tissues, especially helpful for low back pain relief. The reasons for massage vary; for relief from pain and muscle spasms associated with it, for relaxation, for stretching, improved circulation and metabolism.

OSTEOPATH – Osteopaths use Osteopathic Manual Medicine (OMM) to practice medicine based on the theory that conditions in the musculoskeletal system affect other bodily parts. These conditions cause disorders that they believe can hopefully be corrected by manipulative techniques combined with traditional medical, pharmacological, surgical and other therapeutic strategies. Generally within 10 to 14 days, osteopathy relieves low back pain. But there is no evidence to suggest osteopathy as preventative treatment long-term.

CHRONIC PAIN SPECIALIST – A chronic pain specialist is for rare cases and works in teams. He or she generally manages pain relief treatment with psychiatrists, social workers and other medical and counseling healthcare providers.

Method of Back Pain Diagnosis

In order to diagnose back pain for relief treatments, generally health care professional begin by ordering a medical history and physical examination. A look at each of these in depth can shed some light into what to look for and how to find relief from pain. Then we’ll look at specific diagnostic tests. And then where to go for the diagnosis and testing follows.

No matter whether the patient has acute back pain, which is what most have and recover from with around a 4-week period, or chronic, recurring pain episodes, a medical history helps patient an doctor become familiar with one another in confidence to begin or continue a treatment program together. The medical history delves into these areas of the person seeking pain relief: family medical history and personal and work history with regards to back pain episodes and related symptoms and issues, psychological and psychosocial factors, referral source(s) for evaluation and treatment, education on the subject and treatment options, assessment throughout their working together on pain relief treatment and treatment outcomes. For example, if physical therapy needs to be added to the regimen or enhanced, it would be discussed in the medical history and updated as needed.

The medical history incorporates past and present factors of fatigue, fever and weight loss. And it notes any use of drugs or herbs, minerals and supplements. A history of past and present infections, cancer or other conditions is also noted.

The history also includes details about the back pain, focusing on the many facets of the pain: information about any initial injury or trauma, if available, onset, intensity, duration, location, associated symptoms, etc.

The physical examination includes evaluating the person generally inn the “hospital gown” with the body and especially the back in a variety of postures and movement ranges to determine pain symptoms, tenderness and range of motion. So the patient may need to sit, stand, touch toes, move arms, etc. and share any pain symptoms or other information notated with each change along the way.

Neurological testing can also be a part of the routine. A neurologic screening may consist of tests for reflexes, strength of muscles, cramping and a detailed look at sensory issues via various range of motion and movement exercises. Included in this can be an assessment of the legs, upper leg, hip and groin area and pulses for neurological and vascular conditions.

Results may point to a secondary problem like kidney stones or a slight bone fracture, for instance, in which cases, further assessment and treatment options would be considered and discussed in both the medical history and physical examination.

Noteworthy is that patients seeking relief after an extended period can tend to exaggerate or magnify their symptoms out of a variety of reasons; possibly psychological factors associated with fear of the unknown, change, coping alternatives, insurance coverage and treatment costs, previous visits with health care providers, etc. So education and patience is advised to that all bases can be covered, i.e. so that effective pain relief remedies can be determined.

Diagnostic Testing

For back pain relief, any of several tests can be performed; x-rays or radiographs, isotope bone scan (referred to as technetium and SPECT), magnetic resonance imaging (MRI), computerized axial tomography (CAT) scan, myelogram, blood and nerve tests and injections.