Low Back Pain (Holistic)
About This Condition
- Take care of your back
Practice good workplace and lifestyle habits, such as lifting and standing properly; learn proper exercises to reduce low back pain from a qualified instructor
- Consider seeing a chiropractor
A qualified practitioner may be able to help correct spinal problems that contribute to back pain and disability
- Get a checkup
See your healthcare provider to make sure your symptoms are not related to a medical problem
About
About This Condition
The low back supports most of the body’s weight, and as a result, is susceptible to pain caused by injury or other problems. Over 80% of adults experience low back pain (LBP) sometime during their life.1 More than half will have a repeat episode.
It is often difficult to pinpoint the root of low back pain, though poor muscle tone, joint problems, and torn muscles or ligaments are common causes. A herniated or slipped disc may also cause low back pain as well as sciatica, a condition where pain travels down one or both buttocks and/or legs.
Standing or sitting for extended periods, wearing high heels, and being sedentary increase the risk of developing low back pain, as do obesity and back strain due to improper lifting. Up to half of pregnant women experience some low back pain.2 Long hours spent driving a car may contribute to a herniated disc.3 This is possibly due to the vibration caused by the car.4
Many people with low back pain recover without seeing a doctor or receiving treatment. Up to 90% recuperate within three to four weeks,5 though recurrences are common,6, 7, 8 and chronic low back pain develops in many people.9 Low back pain is considered acute, or short-term, when it lasts for a few days up to many weeks. Chronic low back pain refers to any episode that lasts longer than three months.
While low back pain is rarely life threatening, it is still important to have chronic or recurring back pain assessed by a healthcare professional. Potentially serious causes include spinal tumor, infection, fracture, nerve damage, osteoporosis, arthritis, or pain caused by conditions found in internal organs such as the kidneys.
Symptoms
Low back pain may be a steady ache or a sharp, acute pain that is worse with movement.
Healthy Lifestyle Tips
A review of clinical trials concluded that treating low back pain with spinal manipulation (chiropractic or osteopathic treatment) is as effective as, or more effective than, other common approaches, such as physical therapy, medication, and exercise.10, 11, 12
Preliminary data indicate that smoking may contribute to low back pain.13 One survey of over 29,000 people reported a significant association between smoking and low back pain.14 Smaller people (children, women, those who weigh less) are most affected. A study involving people with herniated discs found that both current and ex-smokers are at much higher risk of developing disc disease than nonsmokers.15 Other research reveals 18% greater disc degeneration in the lower spines of smokers compared with nonsmokers.16 Smoking is thought to cause malnutrition of spinal discs, which in turn makes them more vulnerable to mechanical stress.17
One survey reported that people who drank wine healed more quickly after disc surgery in the lower back than those who abstained.18 However, alcohol consumption may cause cirrhosis of the liver, cancer, high blood pressure, and alcoholism. As a result, many doctors never recommend alcohol even though moderate consumption has been linked to some health benefits. For those deciding whether light drinking might help with recovery from disc surgery, it is best to consult a doctor.
Regular exercise and proper lifting techniques help prevent low back problems from developing. Proper lifting involves keeping an object close to the body and avoiding bending forwarding, reaching, and twisting while lifting. Low back pain and disc degeneration are both more likely to develop among sedentary people than those who are physically active.19 However, long-term participation in some competitive sports may contribute to spinal disc degeneration.20
Therapeutic exercise helps people recover from low back pain21 and low back surgery.22 Less clear are details about how this should be done for greatest benefit. In other words, the best type of exercise, frequency, duration, and timing of a program still need to be determined. One study reported therapeutic exercise significantly improved chronic low back pain compared to exercise performed at home without professional guidance.23 Another trial discovered that women with chronic low back pain who began supervised back strengthening exercises at a fitness center were more consistent exercisers than those who started and continued therapeutic exercises at home.24 Both groups experienced significant improvement in pain. However, the supervised group experienced better long-term improvement.
While heavy lifting and other strenuous labor may contribute to low back pain, one trial found that people with sedentary jobs gained more benefit from an exercise program than those who have physically hard or moderate occupations.25 Motivational programs may also improve exercise consistency, which in turn decreases pain and disability.26 People with low back pain who wish to embark on an exercise program should first consult with a physical therapist or other practitioner skilled in this area.
Supervised bed rest, for two to four days, coupled with appropriate physical therapy and therapeutic exercise, is often recommended by medical doctors for acute low back pain.27 However, reviews of bed rest recommendations have concluded that bed rest is, at best, ineffective and may even delay recovery.28, 29 It is better to try to stay active and maintain a normal daily schedule as much as possible.
General recommendations for people recuperating from low back pain include wearing low-heeled comfortable shoes, sitting in chairs with good lower back support, using work surfaces that are a comfortable height, resting one foot on a low stool if standing for long periods, and supporting the low back during long periods of driving.30
Holistic Options
Acupuncture may be helpful in the treatment of low back pain in some people. Case reports31, 32 and numerous preliminary trials33, 34, 35, 36, 37, 38, 39 have described significant improvement in both acute and chronic back pain following acupuncture (or acupuncture with electrical stimulation) treatment. In a single controlled study of acute back pain, both electroacupuncture and drug therapy (acetaminophen) led to statistically significant pain reduction and improved mobility.40
Several controlled clinical trials have evaluated acupuncture for chronic low back pain. A controlled trial found acupuncture was significantly superior to placebo (fake electrical stimulation through the skin) in four of five measures of pain and physical signs.41 Controlled trials using electroacupuncture have reported either benefit42 or no benefit43 for chronic back pain. A double-blind trial compared acupuncture to injections of anesthetic just below the skin at non-acupuncture points, and found no difference in effect between the two treatments.44 Controlled trials have compared acupuncture to transcutaneous nerve stimulation (TENS). Some,45, 46 though not all,47 demonstrated greater pain relief with acupuncture when compared to TENS, and one found improved spinal mobility only with acupuncture.48
In one preliminary trial, acupuncture relieved pain and diminished disability in the low back during pregnancy better than physiotherapy.49
A recent analysis and review of studies reported acupuncture was effective for low back pain,50 though another recent review concluded acupuncture could not be recommended due to the poor quality of the research.51 A third review concluded that acupuncture was beneficial for people with slipped discs and sciatica and could be recommended at the very least as a supplementary therapy.52 Since the vast majority of controlled acupuncture research addresses chronic low back pain, it remains unknown whether people with acute low back pain benefit significantly from acupuncture.53
The federally funded Agency for Health Care Policy and Research has deemed spinal manipulation effective for acute low back pain during the first month following injury.54 This recommendation is supported by other research, though some has not been well controlled.55, 56 People whose initial pain or disability is severe to moderate appear to benefit the most, though those with longer lasting or chronic pain may also be helped by spinal manipulation.57, 58 One 12-month controlled study found no difference in benefit between manipulation and standard physical therapy.59 Another controlled study found a series of eight treatments with spinal manipulation was as effective as conventional medical therapy, but the manipulation group needed less pain medication and physical therapy.60 Practitioners who perform spinal manipulation include chiropractors, some osteopaths, and some physical therapists.
Some researchers suggest that spinal manipulation should not be performed on people with a herniated (slipped) disc, because it may lead to spinal cord injuries.61 However, other preliminary trials report that spinal manipulation helps those with herniated discs,62, 63, 64, 65 as did one controlled study comparing manipulation to standard physical therapy.66 In one investigation of 59 people with slipped discs who received chiropractic treatment, including manipulation, 90% reported improvement.67 Those with a history of low back surgery had poor outcomes. People with LBP due to herniated discs who wish to try this method should first consult with a chiropractor or other physician skilled in spinal manipulation. A recent controlled study compared manipulation, acupuncture, and medication for chronic spinal pain. Only manipulation significantly improved pain and disability scores.68
There is inconclusive evidence that massage alone helps people with low back pain, though preliminary research indicates it has potential.69 Many practitioners use massage in combination with other physical therapies, such as spinal manipulation or therapeutic exercise. People with low back pain who want to try massage should consult with a qualified massage therapist.
Some controlled trials indicate that biofeedback benefits people with chronic low back pain,70, 71 but other trials do not.72, 73 One study found that biofeedback was more effective than behavioral therapy or conservative medical treatment for people with chronic back pain. The study also found biofeedback to be the only method where people experienced significant reduction in pain for up to the two years of follow-up.74 People wishing to try biofeedback should discuss this method with a qualified practitioner.
Emotional distress has been associated with aggravating low back pain,75 including that caused by a herniated disc.76 The effects on back pain of counseling aimed at reducing emotional stress remain unknown, though it is used in some clinics employing multidisciplinary approaches to treating chronic lower back pain.
Supplements
Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
| Supplement | Why |
|---|---|
3 Stars Chymotrypsin and Trypsin 4 to 8 tablets a day of proteolytic enzymes containing trypsin and chymotrypsin, and/or bromelain | Supplementing with a combination of the enzymes trypsin and chymotrypsin may improve low back pain. Three double-blind trials have investigated the effects of supplementing a combination of the enzymes trypsin and chymotrypsin for seven to ten days on severe low back pain with or without accompanying leg pain. Eight tablets per day were given initially in all trials, but in two trials the number of pills was reduced to four per day after two to three days. One of these trials reported small, though statistically significant improvements, for some measures in people with degenerative arthritis of the lower spine. People with sciatica-type leg pain had significant improvement in several measures in one trial, while another found the enzymes were not much more effective than a placebo. These trials included chronic low back conditions, so their relevance to acute LBP alone may be limited. |
2 Stars Phenylalanine 1,500 to 2,500 mg per day of DL-Phenylalanine | Several studies suggest that a synthetic version of phenylalanine called D-phenylalaline, may reduce pain by decreasing the enzyme that breaks down endorphins. Several animal studies and some research involving humans suggest that a synthetic version of the natural amino acid phenylalanine called D-phenylalaline (DPA), reduces pain by decreasing the enzyme that breaks down endorphins. It is less clear whether DPA may help people with LBP, though there are a small number of reports to that effect, including one uncontrolled report of 27 of 37 people with LBP experiencing “good to excellent relief.” In a double-blind trial, University of Texas researchers found that 250 mg of DPA four times per day for four weeks was no more effective than placebo for 30 people with various types of chronic pain; 13 of these people had low back pain. In a Japanese clinical trial, 4 grams of DPA per day was given to people with chronic low back pain half an hour before they received acupuncture. Although not statistically significant, the results were good or excellent for 18 of the 30. The most common supplemental form of phenylalanine is D,L-phenylalanine (DLPA). Doctors typically recommend 1,500–2,500 mg per day of DLPA. |
2 Stars Vitamin B1, Vitamin B6, and Vitamin B12 Take under medical supervision: 50 to 100 mg each of vitamins B1 and B6, and 250 to 500 mcg of vitamin B12, all taken three times per day | A combination of vitamin B1, vitamin B6, and vitamin B12 may prevent a common type of back pain linked to vertebral syndromes and may reduce the need for anti-inflammatory medications. A combination of vitamin B1, vitamin B6, and vitamin B12 has proved useful for preventing a relapse of a common type of back pain linked to vertebral syndromes, as well as reducing the amount of anti-inflammatory medications needed to control back pain, according to double-blind trials. Typical amounts used have been 50–100 mg each of vitamins B1 and B6, and 250–500 mcg of vitamin B12, all taken three times per day. Such high amounts of vitamin B6 require supervision by a doctor. |
2 Stars Vitamin D Refer to label instructions | In people with muscle pain associated with vitamin D deficiency, supplementing with the vitamin may improve pain. Some studies have found that vitamin D levels are lower in people with back pain than in healthy people. In patients with muscle pain associated with vitamin D deficiency, vitamin D supplementation has resulted in improvement in the pain. |
2 Stars White Willow Take an extract supplying 240 mg of salicin daily | Willow bark is traditionally used for pain and conditions of inflammation. According to one study, taking high amounts of willow bark extract may help people with low back pain. Willow bark is traditionally used for pain and conditions of inflammation. According to one controlled clinical trial, use of high amounts of willow bark extract may help people with low back pain. One trial found 240 mg of salicin from a willow extract to be more effective than 120 mg of salicin or a placebo for treating exacerbations of low back pain. |
1 Star Bromelain 4 to 8 tablets a day of proteolytic enzymes containing trypsin and chymotrypsin, and/or bromelain | Several trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions who use bromelain. Proteolytic enzymes, including bromelain, papain, trypsin, and chymotrypsin, may be helpful in healing minor injuries because they have anti-inflammatory activity and are capable of being absorbed from the gastrointestinal tract. Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions who use either bromelain or papain. |
1 Star Chili Peppers Refer to label instructions | Topical cayenne pepper has been used for centuries to reduce pain and to diminish localized pain for a number of conditions. Topical cayenne pepper has been used for centuries to reduce pain, and more recently, to diminish localized pain for a number of conditions, including chronic pain, although low back pain has not been specifically investigated. Cayenne creams typically contain 0.025–0.075% capsaicin. While cayenne cream causes a burning sensation the first few times used, this decreases with each application. Pain relief is also enhanced with use as substance P, the compound that induces pain, is depleted. To avoid contamination of the mouth, nose, or eyes, hands should be thoroughly washed after use or gloves should be worn. Do not apply cayenne cream to broken skin. |
1 Star Devil’s Claw Refer to label instructions | One trial found that devil’s claw capsules were helpful in reducing acute low back pain in some people. One double-blind trial found that devil’s claw capsules (containing 800 mg of a concentrated extract taken three times per day) were helpful in reducing acute low back pain in some people. Another double-blind trial (using 200 mg or 400 mg of devil’s claw extract three times daily) achieved similar results in some people with exacerbations of chronic low back pain. Herbalists often use ginger to decrease inflammation and the pain associated with it, including for those with low back pain. They typically suggest 1.5 to 3 ml of ginger tincture three times per day, or 2 to 4 grams of the dried root powder two to three times per day. Some products contain a combination of curcumin and ginger. However, no research has investigated the effects of these herbs on low back pain. |
1 Star Eucalyptus Topical Refer to label instructions | A combination of eucalyptus and peppermint oil applied directly to a painful area may help by decreasing pain and increasing blood flow to afflicted regions. A combination of eucalyptus and peppermint oil applied directly to a painful area may help. Preliminary research indicates that the counter-irritant quality of these essential oils may decrease pain and increase blood flow to afflicted regions. Peppermint and eucalyptus, diluted in an oil base, are usually applied several times per day, or as needed, to control pain. Plant oils that may have similar properties are rosemary, juniper, and wintergreen. |
1 Star Ginger Refer to label instructions | Herbalists often use ginger to decrease inflammation and the pain associated with it, including for those with low back pain. Herbalists often use ginger to decrease inflammation and the pain associated with it, including for those with low back pain. They typically suggest 1.5 to 3 ml of ginger tincture three times per day, or 2 to 4 grams of the dried root powder two to three times per day. Some products contain a combination of curcumin and ginger. However, no research has investigated the effects of these herbs on low back pain. |
1 Star Papain Refer to label instructions | Several trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions who use papain. Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions using either bromelain, papain from papaya, or a combination of trypsin and chymotrypsin. Double-blind trials have reported faster recovery from athletic injuries, including sprains and strains, and earlier return to activity using eight tablets daily of trypsin/chymotrypsin, four to eight tablets daily of papain, eight tablets of bromelain (single-blind only), or a combination of these enzymes. However, one double-blind trial using eight tablets per day of trypsin/chymotrypsin to treat sprained ankles found no significant effect on swelling, bruising, or overall function. |
1 Star Peppermint Refer to label instructions | A combination of eucalyptus and peppermint oil applied directly to a painful area may help by decreasing pain and increasing blood flow to afflicted regions. A combination of eucalyptus and peppermint oil applied directly to a painful area may help. Preliminary research indicates that the counter-irritant quality of these essential oils may decrease pain and increase blood flow to afflicted regions. Peppermint and eucalyptus, diluted in an oil base, are usually applied several times per day, or as needed, to control pain. Plant oils that may have similar properties are rosemary, juniper, and wintergreen. |
1 Star Turmeric Refer to label instructions | Turmeric is an herb known traditionally for its anti-inflammatory effects, a possible advantage for people suffering from low back pain. Turmeric is another herb known traditionally for its anti-inflammatory effects, a possible advantage for people suffering from low back pain. Several preliminary studies confirm that curcumin, one active ingredient in turmeric, may decrease inflammation in both humans and animals. In one double-blind trial, a formula containing turmeric, other herbs, and zinc significantly diminished pain for people with osteoarthritis. Standardized extracts containing 400 to 600 mg of curcumin per tablet or capsule are typically taken three times per day. For tinctures of turmeric, 0.5 to 1.5 ml three times per day are the usual amount. |
1 Star Vitamin C Refer to label instructions | A preliminary report suggested that vitamin C helped many people avoid surgery for their disc-related low back pain. A preliminary report in 1964 suggested that 500–1,000 mg per day of vitamin C helped many people avoid surgery for their disc-related low back pain. No controlled research has been done to examine this claim further. |
References
1. Cassidy JD, Carroll LJ, Cote P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine 1998;23:1860-6.
2. Cohen KB. Pregnancy and low back pain. California Chiropractic Journal 1989;November:43-7.
3. Kelsey JL, Githens PB, O'Conner T, et al. Acute prolapsed lumbar intervertebral disc. An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine 1984;9:608-13.
4. Frymoyer JW. Lumbar disk disease: epidemiology. Instr Course Lect 1992;41:217-23 [review].
5. Andersson GBJ. Diagnostic considerations in patients with back pain. Phys Med Rehabil Clin N Am 1998;9:309-22.
6. Smedley J, Inskip H, Cooper C, et al. Natural history of low back pain. A longitudinal study in nurses. Spine 1998;23:2422-6.
7. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine 1998;23:1875-83.
8. MacDonald MJ, Sorock GS, Volinn E, et al. A descriptive study of recurrent low back pain claims. J Occup Environ Med 1997;39:35-43.
9. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 1999;318:1662-7.
10. Dagenais S, Gay RE, Tricco AC, et al. NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain. Spine J 2010;10:918-40.
11. Bronfort G, Evans R, Anderson AV, et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain. Annals Intern Med 2012; 156:1-10.
12. von Heymann WJ, Schloemer P, Timm J, et al. Spinal HVLA-Manipulation in Acute Nonspecific LBP: A Double Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo. Spine 2012 [E-pub ahead of print].
13. Leboeuf-Yde C, Yashin A. Smoking and low back pain: is the association real? J Manipulative Physiol Ther 1995;18:457-63 [review].
14. Leboeuf-Yde C, Kyvik KO, Bruun NH. Low back pain and lifestyle. Part 1: Smoking. Information from a population-based sample of 29,424 twins. Spine 1998;23:2207-13.
15. An HS, Silveri CP, Simpson JM, et al. Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord 1994;7:369-73.
16. Battie MC, Videman T, Gill K, et al. 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine 1991;16:1015-21.
17. Ernst E. Smoking is a risk factor for spinal diseases. Hypothesis of the pathomechanism. Wien Klin Wochenschr 1992;104:626-30 [in German, review].
18. Rasmussen C. Lumbar disc herniation: favourable outcome associated with intake of wine. Eur Spine J 1998;7:24-8.
19. Salminen JJ, Erkintalo M, Laine M, Pentti J. Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine 1995;20:2101-7.
20. Videman T, Battie MC, Gibbons LE, et al. Lifetime exercise and disk degeneration: an MRI study of monozygotic twins. Med Sci Sports Exerc 1997;29:1350-6.
21. Campello M. Nordin M. Weiser S. Physical exercise and low back pain. Scand J Med Sci Sports 1996;6:63-72 [review].
22. Manniche C. Assessment and exercise in low back pain. With special reference to the management of pain and disability following first time lumbar disc surgery. Dan Med Bull 1995;42:301-13 [review].
23. Torstensen TA, Ljunggren AE, Meen HD, et al. Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. Spine 1998;23:2616-24.
24. Bentsen H, Lindgarde F, Manthorpe R. The effect of dynamic strength back exercise and/or a home training program in 57-year-old women with chronic low back pain. Results of a prospective randomized study with a 3-year follow-up period. Spine 1997;22:1494-500.
25. Hansen FR, Bendix T, Skov P, et al. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial. Spine 1993;18:98-108.
26. Friedrich M, Gittler G, Halberstadt Y, et al. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998;79:475-87.
27. Rosen NB, Hoffberg HJ. Conservative management of low back pain. Phys Med Rehabil Clin N Am 1998;9:435-64.
28. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997;47:647-52.
29. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229-33 [review].
30. Bigos SJ, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994, 34-6 [review].
31. Lu J. J Tradit Chin Med The clinical application of yanglingquan (GB 34) point. 1993;13:179-81.
32. Shen X. Acupuncture treatment for kidney deficiency with combined application of points mingmen and guanyuan. J Tradit Chin Med 1996;16:275-7.
33. Sun LY.Efficacy of acupuncture in treating 100 cases of lumbago. J Tradit Chin Med 1987;7:23-4.
34. Wang YY. Electro-acupuncture treatment of 55 cases of soft tissue lumbar pain. J Tradit Chin Med 1987;7:72.
35. Weiss SL. Acupuncture in low back pain. Med Times 1975;103:137-9, 144-6.
36. Wilber MC.Sedation of active acupuncture loci in the management of low back pain. Am J Chin Med 1975;3:275-9.
37. Leung PC. Treatment of low back pain with acupuncture. Am J Chin Med 1979; 7:372-8.
38. MacPherson H, Gould AJ, Fitter M. Acupuncture for low back pain: results of a pilot study for a randomized controlled trial. Complement Ther Med 1999;7:83-90.
39. Junnila SY. Long-term treatment of chronic pain with acupuncture. Part I. Acupunct Electrother Res 1987;12:23-36.
40. Hackett GI, Seddon D, Kaminski D.Electroacupuncture compared with paracetamol for acute low back pain. Practitioner 1988;232:163-4.
41. Macdonald AJ, Macrae KD, Master BR, Rubin AP. Superficial acupuncture in the relief of chronic low back pain. Ann R Coll Surg Engl 1983;65:44-6.
42. Thomas M, Lundberg T. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiol Scand 1994;38:63-9.
43. Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Can Anaesth Soc J 1976;23:303-6.
44. Mendelson G, Selwood TS, Kranz H, et al. Acupuncture treatment of chronic back pain. A double-blind placebo-controlled trial. Am J Med 1983;74:49-55.
45. Lehmann TR, Russell DW, Spratt KF, et al. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patientsPain 1986;26:277-90.
46. Laitinen J. Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbalgia and ischialgia. Am J Chin Med 1976;4:169-75.
47. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain 1999;82:9-13.
48. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain 1999;82:9-13.
49. Wedenberg K, Moen B, Norling A. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand 2000;79:331-5.
50. Ernst E, White AR. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med 1998;158:2235-41.
51. van Tulder MW, Cherkin DC, Berman B, et al. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 1999;24:1113-23.
52. Longworth W, McCarthy PW. A review of research on acupuncture for the treatment of lumbar disc protrusions and associated neurological symptomatology. J Altern Complement Med 1997;3:55-76 [review].
53. Bigos SJ, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994, 34-6 [review].
54. Bigos SJ, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994, 34-6 [review].
55. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine 1996;21;2860-71 [review].
56. Verhoef MJ, Page SA, Waddell SC. The Chiropractic Outcome Study: pain, functional ability and satisfaction with care. J Manipulative Physiol Ther 1997;20:235-40.
57. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine 1996;21:2860-71 [review].
58. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128-56.
59. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine 1998;23:1875-83.
60. Andersson GBJ, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med 1999;341:1426-31.
61. Powell FC, Hanigan WC, Olivero WC. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993;33:73-8 [review].
62. Ye RB, Zhou JX, Gan MX. Clinical and CT analysis of 35 cases of lumbar disc herniation before and after non-operative treatment. Chung His I Chieh Ho Tsa Chih 1990;10:667-8645 [in Chinese].
63. Anonymous. Manipulation for sciatica: promising results. The BackLetter 1998;13:122, 125.
64. Kuo PP, Loh Z. Treatment of lumbar intervertebral disc protrusions by manipulation. Clin Orthop Rel Res 1987;215:47-55.
65. Chrisman D, Mittnacht A, Snook GA. A study of the results following rotatory manipulation in the lumbar intervertebral disc syndrome. J Bone Joint Surg 1964;46A:517-24.
66. Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Med 1982;61:273-8.
67. Stern PJ, Cote P, Cassidy JD. A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. J Manipulative Physiol 1995;18:335-42.
68. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther 1999;22:376-81.
69. Ernst E. Massage therapy for low back pain: a systematic review. J Pain Symptom Manage 1999;17:65-9 [review].
70. Vlaeyen JW, Haazen IW, Schuerman JA, et al. Behavioural rehabilitation of chronic low back pain: comparison of an operant treatment, an operant-cognitive treatment and an operant-respondent treatment. Br J Clin Psychol 1995;34:95-118.
71. Newton-John TR, Spence SH, Schotte D. Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain. Behav Res Ther 1995;33:691-7.
72. Bush C, Ditto B, Feuerstein M. A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain. Health Psychol 1985;4:307-21.
73. Stuckey SJ, Jacobs A, Goldfarb J. EMG biofeedback training, relaxation training, and placebo for the relief of chronic back pain. Percept Mot Skills 1986;63:1023-36.
74. Flor H, Birbaumer N. Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol 1993;61:653-8.
75. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 1999;318:1662-7.
76. Heliovaara M, Knekt P, Aromaa A. Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization. J Chronic Dis 1987;40:251-8.
Last Review: 06-01-2015
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