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| Alternative Approaches to Low Back Pain | Building a Stronger Back
"The most predictable way of resolving back problems, based on the scientific literature, is by increasing strength," says Vert Mooney, MD, director of U.S. Spine and Sport in San Diego. "There's good evidence that with chronic back pain, the muscles around the spine become inhibited, and the most rational treatment is a progressive strengthening program."
Ideally, says Mooney, such a program is best done with calibrated equipment that allows the person with low back pain to gradually increase the amount of strengthening involved so that performance and progress can be measured. "With calisthenic-type exercises, it's very difficult to increase the amount of exercise that you do, so you do enough to stimulate repair but not enough to increase pain," he says.
Florida chiropractor Thomas Hyde, DC, stresses the importance of "core stability" in any exercise program designed to strengthen the back and relieve chronic pain.
"I like to use the Swiss ball, for example," he says. "In the very early stages, the person may do nothing more than sit on the ball, learning the basics of what's called 'proprioception,'" a sense of balance and joint positioning. "Then they can move on to leg lifts and other various positions on the ball, to the use of weights or tubing to do strength training exercises while on the ball. In the course of time, the patient should see an improvement in balance and in their complaints about back disorders, and it's a relatively inexpensive approach."
Some other types of exercise, for example yoga, Pilates, and tai chi are just beginning to be studied as treatments for back pain, says the GHC's Cherkin. The primary results of a study of yoga for back pain done at the GHC "looks promising," he reports.
Mind and Body
Chronic back pain may not be all in the mind, but for some people, the answer to conquering it may lie there. "A number of mind-body approaches to treating low back pain have demonstrated success," says Andrew Block, PhD, clinical assistant professor of psychiatry at the University of Texas Southwest Medical Center in Dallas and director of the Well-Being Group, a spine center in Plano, Texas. "The major approaches are what we call 'self-regulation strategies': hypnosis, biofeedback, and relaxation exercises. They're designed to promote muscle relaxation and pain control, reducing the amount of energy used for keeping muscles tight and giving the patient a sense of control over their situation - something you feel like you've lost with chronic pain."
Frequently, says Block, the image he uses to help a patient control pain is one of electricity. "I saw a patient today and we talked about the pain signals coming up their spine like electrical wires. As they feel pain, they'll see the wires glowing," he explains. "When they get into a relaxed, hypnotic state, they'll see the glow decrease, visualize it not flowing as intensely or rapidly, and that enables them to mute the pain."
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