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Complementary and Alternative Medicine: Fair and Balanced

Low back pain: an alternative approach to relief

Because the condition is the result of multiple factors, the best therapy requires a comprehensive approach.

By John Russo/Vicus.com

VICUS.COM (02 March 2000) -- "I should have known better than to try and keep up with a 25-year- old." Juan started to describe his pain with this self-admonishment. "But at 50, I felt in good shape and the invitation to play wally ball sounded like a way to add variety to my typical workout routine that starts with the stationary bike, goes through the Nautilus equipment and ends at the juice bar."

"Now, three months later," Juan continued, "the annoying pain in the small of my back that radiates down my left leg is still there when I lift something or lean the wrong way. Aleve doesnít upset my stomach the way aspirin did, but it also doesnít provide much relief."

One-bounce volleyball 

Wally ball, a.k.a. one-bounce volleyball, is a slightly modified game of volleyball for two to 20 people, where the ball is permitted to bounce once before a player hits it. Of course, players can still hit the ball in flight, but letting it bounce gives those who are not as physically adept in playing the game a chance to keep up with the younger players. Soft, safe balls are also used in place of regular volleyballs to cut down on hand and wrist injuries. 

A common problem with inadequate options 

Juan is among the many millions of Americans who suffer from back pain: in fact, eight out of 10 people in the U.S. will experience back pain during their lives. A valid reason to seek medical attention for this condition is to rule out rare but potentially serious conditions that might masquerade as simple low back pain. 

Among conventional treatments, anti- inflammatory medicines, muscle relaxants, physical therapy, and surgery are not very effective. Anti-inflammatory medicine can damage the stomach, as well as cause bleeding, in addition to kidney, bone marrow and liver problems. Muscle relaxants cause sedation but do little to relax muscles. Physical therapy is safe but seldom leads to long-term relief. Surgery in selected cases may have value, but the problem is identifying those cases in which surgery is the optimal therapy. Following surgery there is also a risk of continued pain, probably due to the formation of scar tissue.

A comprehensive approach 

Developing a treatment strategy for low back pain should be viewed from two perspectives. First, there is the need to provide pain relief. Second, it is important to initiate programs with long-term benefits to the patient.

Complementary and alternative therapies are used for low back pain more frequently than for any other indication. Spinal manipulations for low back pain are helpful when acute and subacute low back pain occurs with or without mild neurological involvement or sciatic nerve irritation. Chiropractic manipulation and osteopathic treatment of acute low back pain have been supported by positive findings in randomized controlled trials and are recommended by several regulatory agencies.

In 1994, the Federal Agency for Health Care Policy and Research (AHCPR; renamed as the Agency for Healthcare Research and Quality [AHRQ] in December 1999) released guidelines for the treatment of acute low back pain, which recommended spinal manipulation -- either osteopathic or chiropractic -- over more typical forms of physical therapy (including traction, diathermy, transcutaneous electrical nerve stimulation [TENS] and ultrasound). National treatment guidelines in Canada and England recommend chiropractic manipulation as a first-line therapy for neck and back pain. 

In addition, a 1999 survey of 50 clinical experts on low back pain concluded that for acute uncomplicated low back pain, chiropractic and osteopathy were effective. For chronic, uncomplicated low back pain, most experts considered acupuncture to be effective. Acupuncture has the additional benefit that it can be started during the immediate post-injury period, rather than waiting the three to five days necessary with chiropractic. The experts perceived homeopathy generally as ineffective for any type of low back pain, while sketchy clinical experience with herbalism for low back pain precluded firm conclusions.

One drawback to chiropractic (or other treatment) is that patients often re-injure themselves and slow their own recovery by failing to pay attention to the elementary rules of back care, which are:

  • Donít bend over, and  
  • Donít reach to the side. 

A well-designed integrative back program also should include careful instruction and demonstration, reinforced by helpful print or videotape instructional tools. For example, clients/patients can be taught how to lift objects properly using the power of the quadriceps muscles in the thigh, sparing the back of needless strain. Some practitioners send their clients/patients to "Back School," where they learn to perform usual movements involved in daily activities in new and "back-smart" ways.

Taking a long-term posture for back health 

It is not clear why back pain becomes chronic. However, it may, in part, be the result of improper movement habits and poor posture. This problem can be addressed through the use of movement re-education techniques and exercise programs such as Feldenkrais movement therapy, the Pilates (pronounced Pi-lah-tees) exercise system and  rolfing. These areas of bodywork offer new approaches to awareness and health, although there are no scientific studies to prove or disprove their value.

Feldenkrais movement therapy was developed to improve ease of movement. It differs from most other schools of bodywork in that it is not designed to structurally alter the body. Rather, the practitioner attempts to communicate to the person a sense of improved self-image and movement through gentle massage, stretching and exercise. 

The Body Control Pilates Method enables exercises to be performed without using the problem area initially. It strengthens supporting muscles to assist the area to be rehabilitated. 

Finally, Rolfing, also known as structural integration, is based on the idea that human function is improved when the segments of the body (head, torso, pelvis, legs, and feet) are properly aligned. Through the use of pressure applied with the fingers, knuckles and elbows, Rolfing attempts to achieve balance and poise by manipulating and stretching of the bodyís fascial tissues to release adhesions.

Conclusion 

It would be an oversimplification to conclude that this patientís complaint is the result of one game of wally ball. Low back pain is a common alignment problem whose onset is probably the result of multiple contributing factors -- an acute incident made worse by a life of movement and posture that places excessive strain on the body combined with too little exercise and an unhealthy diet. It is reasonable, therefore, to conclude that optimal therapy for low back pain requires a comprehensive approach by a team of experienced experts from complementary fields of health care.

John Russo, Jr. PharmD is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with more than 20 years of experience in medical education.

References:

Ernst E, Pittler MH. Experts' opinions on complementary/alternative therapies for low back pain. J Manipulative Physiol Ther 1999; 22:87-90.

Horstman J. The Arthritis Foundationís Guide to Alternative Therapies. Arthritis Foundation, Atlanta, Georgia, 1999.

Redwood D. Contemporary Chiropractic. Churchill Livingstone, New York, 1997.

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Future Medicine Publishing, Fife, Washington, 1994.

The Pilates Institute website. www.pilates.net/