How To Treat Lower Back Pain (34 Different Options)

An Overview of All Your Options for Treatment.....

So You Suffer With Lower Back Pain? We Offer The Largest List Of Treatment Options For You To Consider To Make Sure You’re Not Missing Out On Potential Pain Relief….

How To Treat Lower Back Pain

Your spine is an incredibly complicated structure, making surgery the absolute last option and pain an all-too-frequent occurrence.

In years gone by if you reported to a doctor with back pain pain you would get just two pieces of advice – “rest it and take some painkillers if you need to”. Nowadays much of that advice has been discredited – studies have shown that too much rest actually slows down your recovery (you need to remain active) and much doubt has been cast on the effectiveness and long-term risks of taking painkillers.

Instead, in today’s health market the onus is on you to plan your recovery from an injury or to manage your pain if it more of a long-term occurrence.

Due to the sheer number of different types of treatments available we have only outlined each option below. Once you understand all your options, please click on the relevant links or view our page on ‘What Is The Best Treatment For Lower Back Pain’ where we use data from our most recent member survey (as well as clinical opinion) to rank the Top 10 treatments.

To make it more logical, we have divided the possible treatments for lower back pain in to a number of key sections –  ‘Traditional Advice’, ‘Healthy Life Decisions’,  ‘Chemical Solutions For Pain Relief’, ‘Manual Therapies’, ‘Mindful Techniques’, ‘Psychological Support’, ‘Surgery and Procedures’ and ‘Supportive Equipment’.

If there is one thing that is for certain with any form of pain – it is that what works for some people will not work for others. So while the traditional advice of rest, then try painkillers, then try some physiotherapy if that doesn’t work, may be well-worn, there are plenty of other very useful treatments available. 

Some options are free, others can be expensive – but it is worth trying as many as you can until you find the ‘perfect combination’.

Image containing a woman struggling with lower back pain and the caption 'Ever heard of a complete spine replacement - neither have we, so you better look after it!'

Finding The ‘Perfect Combination’

It may be that you find a complete break from pain with just one treatment (let’s say massage therapy) – in which case brilliant!

However, it is much more likely, especially if you suffer with chronic lower back pain, that you will need several different treatments to keep the pain down. 

This may mean a dose of over-the-counter painkillers and hot/cold therapy when you get a sudden flare-up. This could then be backed up by a weekly massage and a regular session with a TENS machine to reduce the number of flare ups overall and give you better daily mobility. 

Traditional Advice

1. Stay Active And Rest –

This is a bit of a controversial subject as the traditional thinking always said ‘rest and relaxation’ was all that was required. New thinking now says that people who remain as active as possible will now recover quicker.

In reality, the truth is a bit of both. Rest and relaxation is essential in your quiet periods – it helps to reduce your stress levels and get better sleep – both of which actively improve recovery rates.

However, the opposite is also correct in that just sitting around for days on end waiting to feel the miracle ‘go’ button will actually slow your recovery.

A day or two of rest is seen as beneficial (depending on the severity of the injury) and then a gradual return to full duties with normal movements as quick as you can manage it.

Perhaps most important of all is getting a good night’s sleep. Read our article on ‘what is the best position for sleeping with back pain’ for further advice.

2. Back Stretching And Specialist Exercises –

Simple back stretches can greatly help to keep your spine supple and ease you back in to a full recovery fast.

3. Hot And Cold Therapy –

Heat packs typically help to relax the muscles, while cold packs stimulate blood flow which helps to speed up recovery. It is now very common practice to use both at different times for maximum effect.

If money is tight, then a cold bag of frozen vegetables could be used to provide the ice and a hot water bottle or hot flannel for the heat.

Alternatively, ready-made solutions such as hot and cold packs can be bought cheaply from many online stores.

Lifestyle Changes

4. Reduce Your Stress –

Feeling stressed can make things dramatically worse by causing further muscle tension. It is accepted even amongst hospital clinicians, that even some of the longest recoveries are made dramatically shorter you stay positive and actively remove any stress creators.

5. Think ‘Ergonomically’ –

Redesign your home and work to maximise your opportunity to maintain a correct posture and minimise potential lifting. This changes should also consider how/ when you place most stress on your spine and focus on reducing these too.

This may include chairs with better support, a larger computer monitor so you don’t hunch forward and buying smaller quantities of shopping so your bags are lighter to carry.

Even planning your day in advance may help if you can mix up activities so you don’t have long periods of either sitting or standing.

6. Lose weight –

It stands to reason that the heavier you are, the more pressure is put on your spine. Not only that, but men and women with large belly’s can actually cause their own back pain because the weight of their belly is pulling their back forward, creating a hunch and lower back pain.

7. Stop Smoking –

Smoking can substantially increase the risk of you developing osteoporosis of the spine, along with a host of other weakened bone problems. Research has found a definitive link between smokers and a much higher incidence of lower back pain.

8. Change To An Anti-Inflammatory Diet –

Yes, you heard it right! While dieting fills the pages of magazines and websites the world over for people looking to lose, there are certain foods that have been proven to have an anti-inflammatory effect on your tissues. As such then changing your diet can actually reduce the inflammation that is causing your back pain!

The foods in question include the usual suspects – high fibre foods like fruit and vegetables and water, BUT also more specifically for the anti-inflammatory properties are potassium rich foods such as bananas, coconut water and cultured dairy.

Also included are other anti-inflammatory foods such as wild fish and bone broth.

There are also a whole range of supplements that contain anti-inflammatory properties. These include Turmeric and Capsaicin Cream.

Chemical Solutions

9. Painkillers –

As someone who has worked around pharmacy and pharmaceutical products for many years, I do have reservations in ever ‘recommending’ painkillers. These drugs work by altering your bodies sensitivity or perception of the pain messages that your nervous system is trying to send.

Blocking these messages however can create as many problems as solutions, because while on the one hand they enable you to ignore the signs of pain, these signals are transmitted via your brain to stop you further damaging, in this case, your lower back. Take these signals away and you risk causing even more damage through careless movements.

Then there is the risk of pain killer addiction. In 2014, a report by Public Health England cited that more than half of all adults seeking treatment for drug addiction in the UK were doing so for substance misuse related to prescription pain killers. In America, opioid abuse ranks only behind marijuana in people over 14.

Finally, there are the long-term effects of being on painkillers including developing a tolerance resulting in ever-higher doses being needed to prevent the pain getting through as well as the impact on your liver and kidneys of breaking these substances down on a continual basis.

Overall, painkillers are brilliant when it comes to recovering from surgery or a trauma resulting in high intensity, short-term pain. However, as is becoming common knowledge, painkillers for long term chronic pain simply offer so many risks that unless the pain is truly unbearable with anything else, they should be ignored.

Just click on the link or here to learn about the different types of painkiller, what they do and what some of the risks are in more depth.

10. Muscle Relaxants –

This is a particular class of pain relief. Lower back pain can frequently be caused a tightening or spasm of the back muscles. Muscle relaxants work (as the name suggests) by affecting the skeletal muscle function, causing a loss of muscle tone and reducing the chance of the muscle going in to spasm, without reducing the strength of the muscle itself. Muscle relaxants can be broken down in to 2 sub categories – Neuuromuscular blockers that are mostly used during surgery to block a neuromuscular junction and Spasmolytics that work centrally on the brain or central nervous system.

It is the spasmolytics that are typically used for lower back pain.  Muscle relaxants tend to be very effective in stopping the spasm and therefore preventing the pain. However, they do have many varied side effects including making recipients feel ‘high’ (you are not allowed to drive or operate heavy machinery after taking one) and are accepted to be highly addictive, with the very real outcome of muscle relaxant abuse being fatal. For a much more detailed review of muscle relaxants please click here or use the A-Z of treatments above.

11. Pain Injections –

Epidural steroid injections work by reducing inflammation around a compressed nerve. A live X-ray (known as a fluoroscopy) is used to ensure the steroid is injected in to the dural sac that surrounds the spinal cord. Sometimes this is also done without x-ray if, for example, a woman is about to give birth and the pain is too much to bear. They can also be used on a more long-term basis for treatment of fibromyalgia representing with intense pain in the lower spine.

An epidural injection should always be administered by a qualified doctor – but even then there are plenty of anecdotal examples where the injection hasn’t quite been effective and left the respondent with worse pain afterwards. In the very first live pain management meeting we attended, we met a lady who been given an epidural injection during labour (and a 2nd attempt shortly after the first had failed) and was left with chronic back pain having not suffered before – so beware no injection is without some risk.

12. Topical Pain Relievers –

These are creams that are applied to the surface of the skin where pain is present. They absorb in to the skin and join the bloodstream via this method. As with all painkillers (either taken orally as above or rubbed in to the skin), there are a variety of analgesics, NSAIDs or steroids that can be used.

Manual Therapies

13. Chiropractic Treatment –

Chiropractors by definition specialise in treating musculoskeletal problems through a process of physical manipulation. Since the spine is the frame of the entire body, it follows that 95% of their work is on the back – mostly the lower back. They make a living by identifying ‘subluxations’ (misalignments) in the spine. Chiropractors then seek to correct these misalignments in the vertebrae through a series of vigorous and forceful manipulations.

Chiropractic therapy can be quite an aggressive practice, trying to force parts of the spine from being ‘out of alignment’ back in to a recommended posture and is certainly not recommended for everyone. Indeed, the jury is still very much out on just how effective chiropractic therapy actually is in isolation and whether the potential risks are actually worth the benefits. For a much fuller explanation around chiropractic therapy just click the picture….

14. Osteopathy –

Osteopaths aim to improve your back pain by massaging and stretching your joints and muscles. The ultimate goal is to improve your bodies’ circulatory and lymphatic systems. They do this by focusing on increasing the blood supply through physical irritation. Osteopaths will also focus on increasing the flexibility in your joints and massaging away muscle tension.

The difference with osteopathy from other physical therapies is that it focuses on the entire body (not just your back) to provide better body health.

15. Physiotherapy –

Physiotherapy started life as the stretching and manipulation of body parts with controlled exercise to facilitate a recovery or rehabilitation. However, like a number of alternative therapies, it has merged with market demand to offer a whole range of other services, depending on the therapist and the business itself.

Traditional physio’s that are attached to hospitals or local doctors are likely to focus on the traditional goals of restoring movement through manual therapy and education around activities that can be undertaken at home.

Private physios however are likely to use hot/ cold presses, potentially some acupuncture or ‘dry needling’ and various other massage techniques to achieve client satisfaction.

16. Massage Therapy –

Unlike Chiropractic therapy, massage therapy is much less vigorous, does not rely on physically moving internal body parts and can deliver instant results. With so much lower back pain being down to sore muscles or muscle ‘knots’, a massage on your lower back can yield major results – and that’s without taking in to account the proven benefits of relaxation for your and your mind that massage therapy can provide.

Perhaps just as important with massage therapy is that the only downside is the cost – it is highly unlikely you will be in more pain after a massage, unlike with some of the more aggressive physical therapies and also with surgery.

17. Acupuncture –

Very thin needles are used to pierce your skin in very specific places across your injured area (lower back). The goal is to stimulate sensory nerves under your skin and improve blood flow to the desired area, improving healing. Some acupuncturists also use a technique known as ‘cupping’ to draw blood flow to injured areas and jumpstart the healing process.

There is still much controversy as to just how effective acupuncture actually is, but it still occupies a place in the alternative therapies that have been known to make some impact on some people.

18. Aquatic Therapy –

In essence, this is exercise in a swimming pool (frequently a heated one). The combination of the warmth being great for easing tight muscles and the buoyancy of the water taking the weight of your movements, makes this ideal for weight-bearing structures like your back.

Aquatic therapy gives you the perfect opportunity to gently stretch otherwise painful muscles and relax the tension. The benefits are so clear-cut that aquatic therapy has even been recommended by the Arthritis Foundation.

19. Yoga –

There are many types of yoga, used for a whole range of purposes. Broadly however, yoga is designed to strengthen muscles through a range of gradual postures and poses.

20. The Importance Of Stretching Your Hamstrings –

It is a little discussed fact that if your hamstrings are tight, it will directly contribute to your lower back muscles and sacroiliac joints being under stress too. The end result is that tight hamstring muscles will lead to a more painful lower back.

Thankfully there is a simple answer – basic hamstring stretches twice a day should loosen your muscles from your leg to your lower back and help greatly with relieving your lower back pain.

When I suggested this as an option to one individual who went home and tried it, the results were amazing. It certainly didn’t clear up her back pain altogether,but she was very clear that it helped, since she had started stretching them one a day every morning.

Mindful Techniques

21. The Feldenkrais Technique –

This is an exercise-based technique based on separating the connections in your mind between movements and parts of your body. The goal is then to reorganize your thinking to use different parts of your body when carrying out subconscious actions.

If successful, this should help you move efficiently using your body in a different way that reduces your overall pain.

Click here to learn more about the Feldenkrais Method in general or click here (or the photo) to read more about the Feldenkrais Method and Back Pain specifically.

22. The Alexander Technique –

Quite similar to the Feldenkrais Method in it’s focus on separating actions and learning to appreciate the effect on your body of every movement. They differ more in their teaching than the underlying principles.

With the Alexander technique, the focus is much more on achieving the best posture for your body and it’s teaching is much more descriptive – in other words the books/ teachers are much clearer in guiding you to the desired outcome. With the Feldenkrais method, the focus is much more on you to find what works best for you, without a specified ‘correct posture’ or movement.

23. Meditation –

Mediation has two main benefits for pain management – in the first instance it can release endorphins that serve to make yourself feel better, but it can also do wonders for reducing your stress levels.

As has been well proven, increasing stress levels leads to increasingly tense muscles, more pain and sleepless nights. This spirals again creating a heightened sensitivity to pain in the first place.

Psychological Support

24. Cognitive Behavioural Therapy –

Cognitive Behavioural Therapy aims to alter the way you think about your pain. As pain is processed in your brain, the theory is that if you can alter the processor, you can alter the outcome. If you think differently about your pain, then eventually you will start to feel the pain differently as your brain puts a different interpretation on the messages your body sends it.

Non-Invasive Electrical Procedures

25. Transcutaneous Electrical Nerve Stimulation (TENS) –

As someone who has worked around pharmacy and pharmaceutical products for many years, I do have reservations in ever ‘recommending’ painkillers. These drugs work by altering your bodies sensitivity or perception of the pain messages that your nervous system is trying to send.

Blocking these messages however can create as many problems as solutions, because while on the one hand they enable you to ignore the signs of pain, these signals are transmitted via your brain to stop you further damaging, in this case, your lower back. Take these signals away and you risk causing even more damage through careless movements.

Then there is the risk of pain killer addiction. In 2014, a report by Public Health England cited that more than half of all adults seeking treatment for drug addiction in the UK were doing so for substance misuse related to prescription pain killers. In America, opioid abuse ranks only behind marijuana in people over 14.

Finally, there are the long-term effects of being on painkillers including developing a tolerance resulting in ever-higher doses being needed to prevent the pain getting through as well as the impact on your liver and kidneys of breaking these substances down on a continual basis.

Overall, painkillers are brilliant when it comes to recovering from surgery or a trauma resulting in high intensity, short-term pain. However, as is becoming common knowledge, painkillers for long term chronic pain simply offer so many risks that unless the pain is truly unbearable with anything else, they should be ignored.

Just click on the link or here to learn about the different types of painkiller, what they do and what some of the risks are in more depth.

26. Percutaneous Electrical Nerve Stimulation (PENS) –

Another option for your back – almost a cross between acupuncture and a TENS machine treatment – is Percutaneous Electrical Nerve Stimulation (PENS).

The difference between TENS and PENS however is very important to understand – TENS is a safe procedure external to the skin that can be tried at home or anywhere. PENS involves piercing the skin with electrodes to target specifically the nerve endings that are causing you pain.

While neither could be described as dangerous, the much newer PENS treatment should be done by somebody trained to know where your nerve endings are and which are most likely to be the ones causing you pain.

This invariably means a doctor or surgeon carrying out the procedure. Perhaps for this reason, and the fact that the skin is in no way a blocker to the electrical current, PENS treatment suggests a more effective outcome.

Combining the theory of acupuncture stimulating your body to repair the pierced areas, and combining it with the electrical pulses that have been fairly well accepted by Doctors as highly beneficial in TENS use, would make sense for it to be an effective alternative for back pain. 

27. Radiofrequency Denervation –

An even more severe way of tackling the nerves in and around your back is with ‘Radiofrequency Denervation’. In this procedure, radiofrequency waves are used to destroy nerves around the facet joints in your back or neck.

To be more precise, this treatment is used to deactivate the medial branch nerves. As part of the procedure, a needle is inserted in to your back under a local anaesthesia. The needle is then heated with radio waves that kill the nerve endings and make sure they can no longer send any pain messages.

This is a very localised treatment though that only works when the pain is either in your neck or originating from the facet joints in your back. This is more likely in patients suffering with arthritis in the spine.

Radiofrequency denervation is only performed in hospitals and normally only after trying facet injections or medial nerve blocks. This will establish whether the source of your pain is indeed from this particular group of nerves.

It is not however something to be considered lightly. Many patients that have tried it have found it not to be helpful – even after seemingly isolating their pain as being from the facet joints. There is certainly no guarantee of success and destroying nerve in your spine, no matter how localised, should always be a last resort.

Radiofrequency denervation can also be referred to as ‘radiofrequency ablation’, ‘radiofrequency neurotomy’ or ‘facet rhizolysis’.

28. Therapeutic Ultrasound –

Sound waves are passed through your back with the intention of stimulating and speeding up the healing process.

29. Prolotherapy –

This is designed for chronic injuries, particularly those that involve serious tissue damage. The concept is that an ‘irritant’ (often dextrose/ glucose based) in injected in to the damaged tissue next to the painful joint. This injection of a foreign substance triggers your bodies’ immune system, causing it to restart the healing process and start strengthening the ligaments.

Prolotherapy takes several sessions with multiple injections of the irritant in to the injury site (up to 12 shots per session). Total treatment time can be up to six months, but at the end your body should have been prompted to put it’s effort in to healing the damaged tissue around your lower back.

30. Inferential Therapy –

Passing of an electrical current through your spine to speed up recovery.

Surgery

31. Spinal Fusion or Disk Replacement Surgery –

Surgery on your back is at best a very complex procedure, due to extremely complex web of nerves and tendons that surround your spine. Unless it is a last resort, surgeons will be extremely reluctant to start cutting you open as they could easily do more than good.

Spinal Fusion or Disk Replacement Surgery is generally the exception to this as the cause of your back pain is obvious and largely correctable – such as a slipped disk or trapped nerve. In these circumstances, corrective surgery may be a good option.

The other example where surgery might be viable is if your pain has become so extreme that the possible benefits to your quality of life outweigh the risks of damaging a nerve or even the spinal cord in your back. Such a case may be a really degenerative case of osteoarthritis on the spine.

Supportive Equipment

32. Back Braces/ Corsets –

These are quite often seen immediately after a lower back injury. The idea is to provide support to the muscles and ligaments around the spine. These should really only be used for the first few days after an accident, but many people use them whenever they have a flare up in pain.

A really good, supporting back brace can certainly help, but if left on for more than a few days after the accident, can actually weaken the very spine it is supposed to be helping. We explain the pros/ cons of using one in more detail, by clicking here or on the picture below.

33. Specialist Foot Orthotics –

By walking on a special machine, a physio can work out which parts of the foot you put all your weight on. Dedicated in-soles are then made that tilt your feet slightly as you walk, rebalancing your weight and taking some of the strain off your back.

In certain circumstances, the way you walk may actually be a large part of the reason for your back pain. In women, for example, feet that role inward (known as pronation) are a very likely cause of lower back pain.

The Final Word

So that’s a very brief overview of how to treat your lower back pain.

To make it easier, I have attempted to rank many of the most successful options. You can read my personal top 10 favourites as a pain specialist ‘What Is The Best Treatment For Lower Back Pain?’

The truth with treating lower back pain, is there is unlikely to be any single answer. Most people who achieve pain relief do so by mixing several treatments. For example, they may use a TENS machine, alternate hot/cold compresses and have a few painkillers on hand after a particularly hard day.

Think of it like a shopping basket full of goods. You try a few – some work and they stay in your basket and others don’t and so get put back on the shelf. Eventually, you’ll find the best combination for you personally and achieve your goal of pain relief.

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