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Nonsurgical Treatment for Back Pain

Nonsurgical treatment options provide relief from back pain in the vast majority of our patients.

That's why our specialists begin with a conservative treatment approach, using the least invasive techniques possible to reduce your back pain.

Initial stages of treatment may include activity modification, modalities such as heat and ice, and over the counter medications may treat mild to moderate pain.

If the pain does not improve, physical therapy, chiropractic and massage may be added.

Also in certain cases, such as ruptured discs or in patients with pain that does not improve with other conservative measures, image guided spinal injections may provide benefit to improve pain and function.

Nonsurgical Treatment Options

Activity Modification

In the initial phase after developing back pain, relative rest is recommended. Modifying or taking a break from an activity that aggravates inflammation can often give the inflammation time to heal.

  • Complete bed rest more than 1 or 2 days is generally not recommended as studies have shown that it may prolong recovery.
  • Maintaining activity as tolerated is the best course.
  • Avoid frequent bending and twisting.
  • Prolonged sitting greater than 20 minutes should also be avoided if sitting worsens the pain.
  • Avoiding activity that significantly worsens pain, while continuing activity that is not as bothersome, may be the best strategy while one recovers from an injury.

Physical Therapy

Physical therapy is a form of treatment provided directly by an expert in anatomy, biomechanics, and injury, called a physical therapist.

It involves a wide range of treatments including exercises, stretches, and postural education.

A proper physical therapy program can be very effective in the treatment of certain types of back pain.

How is it performed?

Physical therapy treatment varies significantly, depending on the cause of the pain.

There are three basic types of treatment:

  • Passive treatment or modalities. These involve strategies to loosen joints and muscle tension and reduce pain. This might include ice, heat, ultrasound, and electrical stimulation. In general these treatments are used primarily to reduce initial pain, but should not be the focus of treatment. 
  • Manual treatments – sometimes back pain that result in stiff joints or ligaments responds to manual treatment, which involves identifying these tissue restrictions and using hands on mobilization of tissue. 
  • Active physical therapy – this involves therapist guided stretches, strengthening, and exercises to reestablish normal spine mechanics and stability, which aids in recovery and prevents future injury. 
  • Home exercises - the therapist will recommend individualized stretching and strengthening that you will need to do at home on a regular basis. Sticking to these exercises has been shown to improve outcomes. 

How does it work?

A typical physical therapy treatment plan might include one to two treatments per week for four to six weeks.

Home exercises are given to continue between visits.

Physical therapy is performed under the direction of a prescribing physician, and regular follow-up with the physician is important to review progress in relation to an overall rehabilitation plan.

What is the recovery and prognosis?

Physical therapy can often provide immediate pain relief, however most patients require multiple treatments before significant changes occur.

For More Information About Physical Therapy

Learn more about the physical therapy programs offered at EvergreenHealth Rehabilitation Services.

Anti-Inflammatory Medication


Over-the-counter non-steroidal anti-inflammatory drugs (NSAID)—such as Motrin (ibuprofen) and Aleve (naproxen)—and prescriptions—such as Celebrex (Celecoxib)—are short-term options to help reduce pain and inflammation. One NSAID is not necessarily better than another in regard to pain relief and finding one that works for you may require trying several different types.

Prolonged use of over the counter NSAIDs are not without risks and side effects, and should be discussed with your provider. Side effects can include stomach bleeds, liver and kidney damage, and increased risk of cardiovascular events.


An over-the-counter pain reliever that is used to treat pain, arthritis, headaches, and fever. It is generally well-tolerated, but side-effects may include nausea, constipation, and diarrhea. Rarely, even serious side-effects can occur, such as liver damage and severe allergic reactions.

Muscle Relaxants

A class of medications that may be suggested for short-term use to alleviate musculoskeletal pain and spasms. Common prescriptions include cyclobenzaprine and methocarbamol.

Muscle relaxants are generally well-tolerated, but side-effects may include drowsiness, dizziness, blurred vision, dry mouth, headache, nausea, and nervousness. They should not be used in the setting of acute heart conditions such as arrhythmia, myocardial infarction, and heart failure. Tell your doctor if you also use a tricyclic antidepressant such as amitriptyline or nortriptyline.


A class of medications that may be suggested to stabilize membranes of irritated or damaged nerves, thereby reducing pain. They are used for conditions such as diabetic neuropathy and post-herpetic neuralgia, but they also may be suggested for other conditions that cause burning, lancinating, or electric-type pain.

Common prescriptions include gabapentin, pregabalin, lamotrigine, carbamazepine, clonazepam, and topiramate. Side effects may include drowsiness, lightheadedness, imbalance, and swelling in the limbs, depression.

Referral to Alternative Options

Our specialists are dedicated to partnering with you to find the best solutions for your healthcare needs.

Together we will develop a treatment plan that is both effective and matches your treatment philosophy.

For some people, these treatment options may include:

  • Chiropractic
  • Structural medicine
  • Feldenkrais
  • Hellerwork
  • Rolfing
  • Acupuncture
  • Naturopathic medicine

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