What Is The Best Treatment For Lower Back Pain?
Our Top 10 Back Pain Treatments Rated And Revealed...
- 34 Lower Back Pain Treatments
- 1 Pain Survey With 1,561 Responses For Lower Back Pain Treatments
- 1 Pain Specialist To Give A Final Verdict.
…..Broken Down Into A Top 10 And Finally A Winner…..
…..What Is The Best Treatment For Lower Back Pain?
The 2020 Winner For The Best Treatment Of Lower Back Pain – TENS Machine Treatment.
The Challenge –
Today we ponder – what is the best treatment for lower back pain?
We take our extensive list of 34 potential lower back pain treatments in our article ‘how to treat lower back pain’ and break them down in to the top 10 back pain treatments.
We’ll rate and review each potential back treatment to give you a better idea of which one’s to consider trying first.
Before we formed a realistic list though, we wanted to take out anything that didn’t strictly speaking ‘treat’ lower back pain and those we couldn’t measure.
This meant removing all the lifestyle changes, which while having some impact, were not specific enough. We therefore removed –
- Giving up smoking.
- Losing weight
- Reducing stress
- Changing to an anti-inflammatory diet
After much thought we also removed ‘Rest and Recuperation‘ from the top 10 because, although probably 80% of all cases of back pain are gone after a few days of lighter activities, it is not really a proactive treatment.
We felt it important to mention anyway, because recent studies have highlighted a change or flaw in the traditional approach to the rest/ relax strategy.
New Research Into Rest And Recovery
In the old days, people would literally put their feet up with a back injury and do as little as possible for up to a week, before even considering going to a doctor. However, new research has shown that recovery times are much faster and are less likely to incur further injury if you remain active throughout.
That doesn’t mean going back to heavy lifting, especially if that is what caused the back strain in the first place.
Instead, it means getting plenty of gentle exercise – walking, stretching and normal activities without over-doing it.
The reason that moderate activity instead of direct rest is now recommended is the impact of doing nothing on the rest of your body.
Doing nothing, even just for a few days is more likely to cause increased stiffness when you do move, as well as weakening the core muscles around your spine.
This means that when you do start to move again, your surrounding muscles/ ligaments will actually be weaker than just after the injury. This then happens just at the time that you most want to rely on surrounding muscles to help support your lower back.
The accepted best approach in the first 48 hours after hurting your back, unless it is the result of a collision or comes with some of our listed ‘red flags’, is always to rest for a couple of hours with hot/cold therapy (explained later) and then carry on normal activities, just missing out any that might include heavy lifting or pulling.
If you have just had a forceful collision such as a car accident or falling off a ladder, then you need to get to a hospital straight away for a scan to check that you haven’t fractured your spine. If you were to carry on with a fractured spine, you could well end up paralysed.
Pulling Together A Top 10
As part of our research into better methods of pain control, we carry out an annual survey of our members (you may have read about the results of this on other pages). Part of these studies attempt to investigate which pain control methods are most popular and which are the most effective.
This type of assessment always has one major flaw though – some treatments are very effective in the short run, but ineffective or worse still actually dangerous in the long run.
Then there are the treatments that work by building up over time, or that take time to learn to perform them right, with maximum efficiency.
Overall then, trying to judge what is the best treatment for lower back pain is fraught with complications.
However, when you’ve got a potential 34 options for treating lower back pain (more depending on how you classify them), it really can be a minefield to know where to start and we hope our top 10 will provide you with some help.
We have painstakingly pulled out the 10 most popular treatments for lower back pain and rated them based on a series of criteria – Short-term effectiveness, Long-term effectiveness, Side Effects, Cost and Convenience.
As always, this list has been created by myself as a pain specialist (see bio above).
Any initial diagnosis should be carried out using x-ray and CT imaging to be certain – as provided in surgeries/ hospitals, especially if you are experiencing any of the back pain ‘red flags’.
In reality though, I appreciate this is often not the first point of call.
But either way, there are then a huge range of potential treatments available to you that your doctor is likely to be very happy for you to try and to manage/ assess the results yourself.
The Best Treatment For Lower Back Pain – The Top 10
1. TENS Machine
3. Massage Therapy/ Osteotherapy
4 Hot/ Cold Therapy
6. Foot Orthotics
7. Aquatic rehabilitation
8. Back Braces
9. Spinal Injections
10. Chiropractic Treatment
What Is The Best Treatment For Lower Back Pain….
1. TENS Machine Treatment
- Short-term Effectiveness – 9/10 (Works for most people)
- Long-term Effectiveness – 5/10 (Can be used regularly with very little risk)
- Pain Relief Score – 9/10
- Side Effects – 9/10 (Only risks are very minor burns or tolerance)
- Cost – 7/10 (One-off cost if purchased for home use)
- Convenience – 9/10 (Can be used almost anywhere)
A TENS machine works by transmitting small electrical pulses to you skin. These are then designed to act both to disrupt the normal pain signals to your brain and produce endorphins that act as natural pain relievers.
For much more detailed information, please see our article on ‘how does a TENS machine work’.
TENS Machine Treatment gets the nod as the overall best treatment for lower back pain, because it has some considerable upsides and very few downsides. TENS machines provide mainly short-term pain relief, but can be used numerous times as and when required.
They don’t have the inherent long-term health risks of chemical painkillers, but are convenient enough that a TENS machine can be worn discreetly while you at work or at home.
The only minor issue might be the initial cost (from $50-$250 depending on the quality/ functions), but even this is nothing in comparison to the costs of a physiotherapist or chiropractor.
A better TENS machine will give you a much better result however, and I cover what to look for when purchasing at the bottom of my article ‘what does a TENS machine do’.
- Short-term Effectiveness – 9/10
- Long-term Effectiveness – 1/10 (Most no longer recommended long-term)
- Pain Relief Score – 8/10
- Side Effects – 2/10 (Sickness, diarheoa and increased chance of stroke/ heart attack amongst many)
- Cost – 5/10 (Can be expensive, depends on drug and country)
- Convenience – 6/10 (Some require prescription)
Painkillers are of course the ‘first choice’ for many people on first feeling a twinge of pain in your back – and rightly so.
They are normally the first thing to be prescribed by your family doctor, along with some physiotherapy. You will normally be offered something simple like an NSAID (Ibuprofen) or advised to get some Paracetamol (acetaminophen).
All the common painkillers are effective in their own ways, but have slightly different effects and strengths. Ibuprofen, Naproxen etc are well known for their anti-inflammatory effect (hence the name ‘Non-Steroidal Anti-Inflammatory Drugs’), while paracetamol has a much less anti-inflammatory effect.
The downside with painkillers is that, even the most common ones, have a host of potential side effects.
In the short-term these tend to be mild side effects such as sickness, drowsiness or diarheoa. These can normally be avoided by changing to a different drug as soon as they start to take effect.
For muscular strains, there are also a group of topical analgesics that can act as a counter-irritant – interrupting the nociceptors pain signal.
These typically carry less side effects than tablets, albeit brands such as ‘Deep Heat’ or ‘Tiger Balm’ that claim to offer the benefit of heat as well, which is neither proven or possible for a cream to achieve.
3. Massage Therapy
- Short-term Effectiveness – 8/10
- Long-term Effectiveness – 6/10 (Can last up to a few months, but mostly 2-4 weeks)
- Pain Relief Score – 9/10
- Side Effects – 10/10
- Cost – 3/10
- Convenience – 5/10 (Unless you have a partner who is happy to learn at home)
Massage therapy scores very highly because again it has multiple benefits including stress relief and better circulation (as well as pain relief).
It is nowhere near as aggressive as chiropractic treatment and there is clear clinical benefits to it’s use. The side effects are also as close to nil as you can get for any ‘treatment’.
The only real downside is the cost of regular sessions with an experienced massage therapist.
However, this too can be overcome if you have a partner who’d be happy to learn some simple techniques with oils and a training book.
I’ve covered the benefits of massage therapy in more detail here. It can take many forms, and of course some are more ‘stress relief’ than ‘muscle manipulation’.
However, given the effect of stress on heightening pain sensations, almost all massage is a positive.
4. Hot/Cold Therapy.
- Short-term Effectiveness – 8/10
- Long-term Effectiveness – 3/10 (can be used long-term, but effects don’t last long)
- Pain Relief Score – 6/10
- Side Effects – 9.5/10 (If you don’t use raw ice on skin or spill boiling water)
- Cost – 9/10 (Free)
- Convenience – 9/10 (Easy)
Hot and Cold therapy has been working since the dawn of time.
It scores well for both short term and long term effectiveness, although it should be pointed out that, in the case of back pain, heat therapy tends to work better, partly because the effected muscles are often deep within your back and harder to reach with a cold compress.
It is a cheap treatment, even with hot water bottles or hot/ cold compresses, the cost is not great. Another massive advantage is the lack of side effects and as you can see, almost everyone with lower back pain has tried it and found some success at one point or another.
Cold treatment is great when applied immediately after an injury or exercise. The cold slows down the rate of blood flow to an injured area.
This slows down the rate of inflammation and also acts as an anaesthetic by also slowing down the pain messages sent to and from the brain.
Cold therapy is best done with a bag of frozen vegetables or a cold compress. A cold, wet towel can be used, but only works very short-term.
Hot therapy works even better for back pain. The heat works by increasing blood flow, dilating the blood vessels and helping sore muscles to relax.
Hot therapy can be applied with hot water bottles, heat compresses or just by having a hot bath.
- Short-term Effectiveness – 5/10 (mostly designed for long-term rehab)
- Long-term Effectiveness – 9/10
- Pain Relief Score – 4/10 (Not particularly designed for immediate pain relief unless getting a sports massage)
- Side Effects – 8/10 (None, providing you follow up with given exercises at home)
- Cost – 4/10 (Can be expensive if you have to go privately)
- Convenience – 5/10 Most physio has to at least be started by a trained practitioner who can assess your position and put together a plan)
The Verdict –
Physiotherapy is the traditional 1st choice for rehabilitation after a knee or hip replacement. Physio’s work by getting you to move and exercise the part of your body that is recovering in a safe and constructive way.
Physio in it’s purest sense is slightly less effective with back pain because it is not always clear what the problem is. Is it muscular? Is it skeletal? If it’s pain between the discs, how do exercise that?
In such circumstances, they are likely to resort to offering advice on better posture, getting a better understanding of what activities make your back hurt and possibly offering some form of massage therapy to help loosen the muscles.
They may even recommend testing on a ‘gaitscan’ machine to measure how you balance your weight as this
Physio will always score fairly highly because it has few side effects (if done carefully) and can be convenient as you can continue some elements at home (such as a change in posture or strengthening exercises).
6. Foot Orthotics
- Short-term Effectiveness – 1/10 (Need to go through analysis of gait and then get specialist orthotic made. After this, pain relief can be quick)
- Long-term Effectiveness – 8/10 (Assuming issue is related to balance)
- Pain Relief Score – 7/10 (Can fix the problem permanently)
- Side Effects – 9/10 (None)
- Cost – 7/10 (This varies of course, but is typically a one-off charge rather than a series of charges)
- Convenience – 3/10. (Has to be properly managed and designed by other parties)
The Verdict –
Sometimes your back pain can be caused by a mis-balance in your weight distribution. This can cause you to unconsciously put more weight on your heels or your toes or on one foot over the other.
All of this can cause lower back pain.
The solution in such a case is a personally designed orthotic.
Typically, you will first be asked to walk over a special treadmill as you would normally walk. This is sometimes known as a ‘gaitscan’ machine as it measures the weight distribution and scans your ‘gait’ (manner of walking).
The machine will then produce an exact measurement of your ‘gait’ and from this a recommended insole. This insole is built especially to ‘rebalance’ your weight distribution. It may be build up more in the heel, the toe or on different sides, with the specific purpose of correcting mistakes in the way you walk that are causing you lower back pain.
We scored this at number 6, because again the side effects are nil, and it can be very effective, but it only works if your lower back has been caused by walking incorrectly in the first place.
7. Aquatic Rehabilitation
- Short-term Effectiveness – 4/10 (Designed for long-term rehab)
- Long-term Effectiveness – 9/10
- Pain Relief Score – 5/10 (Water is great for reducing weight or gravity-related pain
- Side Effects – 8/10 (Further injury if rehab is not conducted at the right pace is the only real risk)
- Cost – 2/10 (Can be very expensive depending on where you go and whether you opt for 1 to 1 treatment.
- Convenience – 3/10 (Has to be in a swimming pool or specialist centre).
The Verdict –
Aquatic rehabilitation comes in various forms. At it’s simplest it could be considered to be just swimming/ exercising lightly in a warmed pool. You could also join classes or opt for 1 to 1 classes with a special therapist.
The benefits are that the water takes your weight, so exercises are easier to perform with far less impact and less strain on your back. The warm water is also known to help to soothe/ relax the muscles around your spine.
The problems are the limited availability of therapists, the cost which can be prohibitive depending on where you live and the inconvenience of having to go to a local, public pool during opening hours.
8. Back Braces
- Short-term Effectiveness – 8/10 (Can be used short-term to provide vital extra support in certain cases)
- Long-term Effectiveness – 2/10 (Back braces should never be used as a long-term solution)
- Pain Relief Score – 6/10 (Can provide some pain relief by providing extra support and correcting poor posture)
- Side Effects – 4/10 (back braces will cause a weakening/ wastage of muscle around the spine if you rely on braces regularly)
- Cost – 6/10 (Quite cost effective)
- Convenience – 6/10 (Can be purchased easily, although it is important to research them properly)
The Verdict –
Back braces are a tricky treatment to evaluate. If used well, they can be an essential part of a recovery from injury, providing support through a crucial period of rehabilitation and effectively a ‘spine outside a spine’.
However, with so many people now using them to hide normal non-impact and non-surgical back pain, they are notorious in pain management for doing more harm than good.
Ultimately, if not used in the strictest of circumstances, a back brace can actually destabilise and weaken the muscles around your spine, giving it less support and causing much greater damage in the long run.
The cost is not prohibitive, even for a good quality one, but the amount of people using back braces incorrectly means it really cant score any higher.
9. Spinal Pain Injections
- Short-term Effectiveness – 7/10 (Doesn’t always work and can cause serious damage)
- Long-term Effectiveness – 1/10 (Frequent steroid injections are not a good idea)
- Pain Relief Score – 7/10 (Not always successful).
- Side Effects – 3/10 (can be serious if injection point is not perfect and steroid use is never ideal)
- Cost – 4/10 (If paid for, then you’ll find these can be expensive)
- Convenience – 5/10 (Needs a consultant to administer)
The Verdict –
Painkilling injections are often a last resort before actual spinal surgery.
They are good if you have severe, debilitating back pain that normal pain control cannot touch, especially if a short-term anaesthetic is added to give instant pain relief including against the injection pain itself.
Typically, these are never used long-term for several reasons including concern around the continued use of steroids and the increased likelihood of something going wrong such as an infection or unintentionally clipping a nerve with the needle.
They also only last for a maximum of 3 months (many a lot shorter) and so while they may provide essential relief for a short period of time, they carry considerable risks and cant be rated any higher than 9th.
10. Chiropractic Treatment.
- Short-term Effectiveness – 5/10 (Has been known to work straight away, but can also leave you feeling worse for a day or two)
- Long-term Effectiveness – 1/10 (Very little proof has been found in clinical trials behind it’s long-term benefit)
- Pain Relief Score – 5/10 (Only really gets a 5 because a few ‘select’ people swear by it).
- Side Effects – 4/10 (can actually make your spine worse if forceful alignment is not administered carefully)
- Cost – 2/10 (can be expensive and normally need quite a few sessions)
- Convenience – 3/10 (Needs a consultant to administer)
The Verdict –
Chiropractic treatment only really made it in to my top 10 because of the sheer number of people now trying it for the first time.
I have already written an article trying to separate the facts (clinical evidence) from the fiction (a chiropractor preaching it’s greatness).
Unfortunately, the hard evidence and most of the scholars that had tried to review chiropractic treatment seemed to think it was a lot more ‘clever marketing’ than factual benefit.
Indeed, it was suggested by some doctors and researchers that the lack of research into the efficacy of chiropractic treatment was mostly down to an industry that was worth millions and was terrified that it might collapse if a genuine comparison study was ever fully carried out.
However, some people do claim miraculous recoveries as a result of chiropractic treatment, so although the successes are never revealed against % of did not work or made it worse, they still had some claim to efficacy.
The key reasons it ended up at 10, was the cost, the lack of convenience and the side effects that can happen with such a vigorous procedure. These side effects include severe damage to the spine and greatly increased risk of stroke.
Other Notable ‘Near Misses’
– Hamstring Stretches.
This was a really great tip that I have spoken to people for whom it really worked. Again, it comes down to why you are suffering back pain in the first place. Some people find they have tight hamstrings, which leads to tightened sacroiliac joints and ultimately lower back pain.
By stretching their hamstrings regularly, they were then able to loosen the connections and ultimately cure their back pain.
It’s a great treatment, but didn’t make it to the top 10 because not enough people suffer with that type of lower back pain.
This was a close call, as yoga that is designed to strengthen your core and spine can be highly effective in treating back pain. However, the fact that many of the yoga positions are not supportive of the spine at all (some are quite dangerous) and the idea that yoga instructors are not necessarily trained to help with lower back pain, sat against it.
I’ve sat in several clinician-only meetings of various acupuncture society meetings in which family doctors that also offered acupuncture argued at length as to how effective it was for lower back pain.
Much of the scientific evidence on it’s clinical effectiveness is also up for debate. It seems to me to have better success with shoulder pain, where the nerves are much nearer the surface of the skin.
For that reason, the side effects that include pain the next day and the occasional case of a punctured lung where needles were inserted too far, as well as the cost, saw acupuncture just miss out on a place in the top 10.
The Final Word –
So What Is The Best Treatment For Lower Back Pain? Well, the simple truth is there is no single ‘best’ treatment for lower back pain. TENS machine treatment made it to no1 for it’s sheer versatilitiy and adopted effectiveness.
The cause of your back pain is actually what determines what is the best treatment for lower back pain. Whether it was caused by injury, forceful impact, or something else is essential to making a decision.
Furthermore, it would be naïve to ever narrow treatment down to just one option – even if you opt for TENS machine therapy, there is no reason you shouldn’t use a painkiller occasionally if you need it before treatment, or hot/cold therapy in the evening before bed.
In reality, you need to find your ‘best combination’ of therapies for controlling your back pain. The exact combination will be different for everyone.
But only then, can you be sure you have found the best treatments for your back pain.
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References Used –
1. Cambridge English Dictionary. Search ‘Gait’
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