IstockphotoTrent Northcutt, 42, a corporate executive in New York City, had been suffering from lower back pain and leg pain for about three years, to the point that he was "cautious about picking up the simplest thing," he remembers.
When he finally sought help, his doctor recommended acupuncture right off the bat. Northcutt ended up having six treatments over about eight months. Now, he says, "I don't have any back pain at all. I'm 100% good."
More than 26 million Americans ages 20 to 64 suffer from ongoing back pain, according to the American Pain Foundation, and it's one of the top reasons people visit a doctor. But many of those millions also discover the painful secret about back pain: This common condition can be surprisingly difficult to treat.
The lower back is a complex spot, with many potential sources of pain. Although surgery would seem to be a quick fix, in reality about 85% of people don't need—and won't benefit from—back surgery, says Anders Cohen, MD, chief of neurosurgery at the Brooklyn Hospital Center, in New York City.
That leaves plenty of room for alternative and complementary therapies, such as vitamins, acupuncture, and chiropractic therapy, that may help soothe the pain. "If I don't see something unstable, something wrong with a disk or a bone, I use alternative therapies on a regular basis. It's a central crux of my practice," adds Dr. Cohen.
"There are some types of back pain that seem to be in the covering of the muscles or in the tissue connecting the muscle that are really difficult to treat," adds James Bray, MD, a sports medicine physician with Scott & White Healthcare, in Georgetown, Texas. "That's where a lot of alternative therapies [such as acupuncture and chiropractic therapy] really excel."
One of the first and most effective recourses for people with chronic back pain is acupuncture. "We've had great success with acupuncture. It's great for someone who gets pain that's situated in the back or neck and is not radiating down the arms and legs so much," says Dr. Cohen, who is a retired tennis pro. "I've had it myself, gotten up, and felt 75% better."
Practitioners of Eastern medicine say that acupuncture works by realigning the energy meridians and rebalancing the body. Western doctors don't really know why there's a benefit. Still, they find that it can help in many cases. "We don't have a correlate for that in Western medicine, but it seems to work," Dr. Cohen says. "We just don't have a Western explanation."
Next Page: Massage [ pagebreak ]Massage
Massage could benefit people who want to maintain their back health and who get occasional soreness. Its effects have been studied and explained.
"Massage is not only stretching the muscles and getting out the knots but also manipulating lactic acid and lymphatic draining in [the] body," Dr. Cohen says. "When people are sore, that means a buildup of lactic acid or waste products in the muscles. Massage moves lactic acid faster from the muscles. It's like fast-forwarding the waste products out of your body to help it heal faster."
The key, says Dr. Bray, is to find a masseuse whom you connect with and trust. "If you have a good masseuse, it's great," he says. "If you don't, they can totally mess it up."
Although most people tend to think of a chiropractor as a practitioner who cracks your back while you lie on a table, they also "have a lot of soft tissue treatments," Dr. Cohen says.
Chiropractors can help with back pain and, in a few cases, even pain that radiates into the buttock or leg.
Some borrow techniques from physical therapy, using ultrasound and heat to break the cycles of muscle spasms and trigger points that cause chronic irritation, he says.
And it turns out that the cracking sound that goes along with a visit to the chiropractor is a good thing. Doctors think that it comes from nitrogen bubbles being released in the joints. "That helps rebalance the spine," Dr. Cohen explains.
Pilates and Yoga
One hailing from Germany and the other with roots in Hinduism, Pilates and yoga can help maintain your back and stave off soreness, says Dr. Cohen.
"These are techniques that work on body symmetry, muscle strengthening, breathing, coordinating strength, flexibility, coordination in the body, and body symmetry, so you get your body in right alignment, which makes you feel better and more resistant to injury and fatigue," he explains. "It does make sense."
"Men and women tend to carry weight on the hips and abdomen because that's the center of gravity," Dr. Cohen continues. "The concept of Pilates is to strengthen the abdominal muscles and hips—which are like the Grand Central Station of your body—by keeping [them] functioning and flexible. It's an insurance policy against injury and wear and tear."
But they are not activities for people with degenerated or herniated disks. "Types of yoga that really focus on flexibility and really stretching the spine may actually be counterproductive to somebody who has degenerative spine changes or has a stress fracture," says Kostantinos Vasalos, a physical therapist and coordinator of the spine rehabilitation program at the University of Rochester Medical Center.
Next Page: Strengthening exercises [ pagebreak ]Strengthening exercises
Activities like sit-ups or crunches are designed to maximize muscle contraction. But strengthening exercises can also be counterproductive and need to be used judiciously.
"You get stronger, but you also get a lot of spinal compression. So if you do these with spine issues, you may compress the spine and increase symptoms," warns Vasalos.
Like Pilates and yoga, aerobic exercise is more for people who need to keep in shape and maintain a healthy back, not for those with acute injuries.
"Aerobic exercise makes the muscles more efficient over time," says Dr. Cohen.
And walking is a good way to exercise the muscles of the back, Vasalos says. However, to be effective, walking has to be at a brisk pace and has to be continuous and done regularly.
"Walking is a more natural position for the back than sitting," Dr. Cohen explains. "If you sit in a low chair or low car and the hips and knees come up, it takes the curvature out of the back and aggravates the strain."
For people who are 60 or older and have, for instance, a disk that is compressing a nerve, walking in a pool or interval bicycling are likely to be more comfortable, Vasalos says.
"That will help build some of the muscles around the spine," he adds.
And fast-paced exercises should not be used for a pain flare-up, Dr. Cohen warns.
A large Norwegian trial published in the July 7 issue of the Journal of the American Medical Association has cast serious doubts on the value of glucosamine for chronic lower back pain associated with osteoarthritis. Participants in the study took 1,500 milligrams of glucosamine a day for six months, but didn't see a benefit of the supplement.
Researchers aren't ruling out that glucosamine may have preventive effects or may have effects over several years, though. And glucosamine seems to be safe. So if you think you're benefiting in some real or imagined way, there's no harm in continuing.
Next Page: Vitamin B12 [ pagebreak ]Vitamin B12
Some people swear by vitamin B12. However, there's really no indication that it has any direct effect on low back pain, experts say. Instead, any benefit may come from the energy boost it bestows.
"It's really more of a pick-me-up," Dr. Cohen says. "Patients feel it has a way of jump-starting the system. It does give you energy but, in terms of healing capacity, I wouldn't say it's much more beyond that."
One long-term strategy to maintain bone and back health is vitamin D.
Some spine surgeons are "really, really pushing that as far as maintaining good bone health, especially as we age," says Vasalos, who recommends that every patient take 2,000 international units (IUs) of vitamin D and 1,000 mg of calcium citrate daily.
The National Osteoporosis Foundation recommends 400 to 800 IUs of vitamin D daily for adults under 50 and 800 to 1,000 IUs for those 50 and older.
This is especially important because, according to the American Academy of Orthopaedic Surgeons, as many as 1 billion people worldwide are deficient in vitamin D, which is crucial for bone health.
Vitamin D is present in some foods, such as cod liver oil, some fish, and fortified milk, but it is largely synthesized in the body after exposure to sunlight. Still, that's not an excuse to roast in the sun—just 10 to 15 minutes of sun exposure sans sunscreen is enough to generate an adequate amount of vitamin D. Even better, many multivitamins will give you 1,000 IU of vitamin D.
"Some people feel that back pain, especially in chronic patients, almost becomes as much of a psychological condition [as a physical one], especially if doctors can't find anything physically wrong," Cohen says.
Biofeedback, hypnosis, and cognitive behavioral therapy have been shown to be of benefit.
"These try to reset a patient's mind, retrain the mind to help lower pain," Dr. Cohen says. "I think that's a little more out on the fringe…but every once in a while, you can't find out what's wrong. And the idea is not to give up on the patient but to find a different angle of attack so they can feel better."