Non-Operative Treatments

Medicine

There are several classes of medications that can help provide pain relief. Anti-inflammatories are a mainstay of treatment for disc degeneration and arthritis in the spine. Nerve medicines, such as Neurontin or Lyrica, can provide relief when patients have pain radiating down their arms or legs. Steroids can provide immediate, significant help in patients with severe lumbar radiculopathy or cervical radiculopathy. Muscle relaxants and narcotics can be used for acute pain but should be used carefully due to the risk of addiction.

Physical Therapy

Learning and performing the proper core strengthening exercises for the back and abdominal muscles is crucial for the long-term health of the spine. Nearly all patients who have recurrent problems with the spine should be involved with physical therapy at some point in their treatment. Neck and low back pain without symptoms in the arms or legs should be initially treated with therapy. It is also indicated for patients with arm pain from a pinched nerve. Therapy can worsen symptoms when patients have acute lumbar radiculopathy but is frequently indicated once those symptoms have disappeared. Learning the proper exercises decreases the chance of the return of symptoms. Dr. Button works closely with several physical therapists in Oregon and southwest Washington and can recommend a local therapist for his patients.

Yoga

Yoga is an umbrella term that encompasses many different practices rooted in Eastern philosophy, including mindfulness, breath control, and specific physical postures. Some styles of yoga are very gentle and involve little physical movement, while others are much more vigorous, combining aerobic, strengthening, stretching, and balance exercises. This variety makes it easy for patients with back pain to find a style of yoga that appeals to them but makes it challenging to issue generic recommendations about “yoga” since its practice can vary so much.

Running

The popularity of running is high and continues to increase. Running involves repetitive movements with little variation. As a result, the vast majority of running-related injuries are chronic overuse injuries, mostly involving the lower limbs. It is estimated that between 27-70% of recreational and competitive runners will sustain some type of overuse injury, yet the spine is involved in only around 10% of all running-related injuries.

Pilates

Joseph Pilates initially introduced “Contrology” in the 1920s as a conditioning program for dancers. In the last decade, Pilates has become a popular form of exercise and a method used to treat low back pain (LBP) (Sorosky, Stilp & Akuthota 2008). A less demanding modified method of Pilates was developed for current rehabilitative purposes to improve neuromuscular control of the lumbopelvic stabilizing muscles. Theoretically, improved motor control of the active lumbar stabilizing system may decrease low back pain (Panjabi, 1992). (Wells, Kolt & Bialocerkowski, 2012) performed a systematic review with the objective of determining standard characteristics and definitions of Pilates. The “Modified Pilates” approach requires core stability, strength, flexibility, attention to muscle control, posture, and breathing. Exercises are performed on mats as well as on special equipment. 

Injections

Injections in the neck and back are usually either epidural steroid injections or facet injections. Both types of injections are done under x-ray guidance by a fellowship-trained spine physician. Dr. Button works closely with four injection specialists, so he can match a patient’s problem and location with an expert who can help them. Epidural injections can be very effective for pain radiating down an arm or leg. Facet injections are indicated for neck or back pain that comes in the position of extension.

Alternative Medicine Options

Alternative medical treatments include acupuncture, massage, chiropractic or osteopathic manipulation, yoga, and pilates. Although there is limited data proving that these options will work there are many situations, especially in patients who have failed more traditional treatments such as therapy or medicines, when trying an alternative treatment is indicated. Dr. Button provides a list of recommended alternative medical providers for those patients who would like to explore these options.