Most of the treatments and interventions commonly used to relieve back and back-related leg pain have not been scientifically proven to be effective. But many back pain sufferers report that they have gained significant relief from one or more of these approaches. While some can be done at home, others require that you see a health professional.
How long should you try a specific therapy or treatment? While the treatments listed here may not shorten your overall recovery time they may give you temporary relief and that is a good thing. It’s important for you to keep track of how you’re doing, noting when you had a treatment, whether you felt better afterward, or if your symptoms remained the same or became worse.
IMPORTANT If you’re being treated by a health care professional and don’t notice any improvement after a reasonable amount of time, about six weeks, you should talk with your care provider and consider whether it’s time to try a new approach.
Acupuncture involves inserting tiny needles into various points on the body to relieve pain . According to traditional Chinese medicine, acupuncture points are situated along specific “life energy” pathways although many studies have found that the needles can be put almost anywhere and have the same effect. If you’d like to try acupuncture, find a reputable practitioner who is certified in providing this treatment, who appears to maintain good hygiene and who uses disposable needles (to reduce risk of infection). Most physicians believe that acupuncture is just an elaborate form of placebo but, as so often with back pain, it works for some people. The benefits, if any, should come within a few weeks of starting treatment. Acupuncture should never make the back or leg pain worse.
Injections into the spine
Some treatments for back-related leg pain involve injecting medication directly into the spinal canal. The injections—which should only be performed by a medical doctor—may be an anaesthetic (aimed at dulling your perception of pain) or anti-inflammatory (to reduce inflammation which may be causing pain).
The most commonly prescribed procedure is injecting steroid-containing drugs directly into the canal just outside the sac containing the spinal nerves (the epidural space). Such injections are usually recommended for specific problems when the leg pain is caused by direct nerve root involvement and, if the symptoms are not controlled, surgery may be indicated. One or more injections may reduce the intensity of the pain. It may also shorten how long such disabling symptoms last.
A second type of spinal injection is used to try to stop pain coming from the small joints (facet joints) between the vertebrae. These joints have the same structure as larger joints, like the knee, and an anaesthetic injection (often with added steroid) may stop the pain – at least temporarily.
A third sort of injection is not actually into the spine at all but into the areas of referred pain. These can be in the back muscles and are frequently located in the upper buttocks. A local anaesthetic is injected to stop the local pain and this seems to sometimes break the pain cycle and end the attack. Of course, the injection did nothing to the spine and has no lasting effect so the pain can certainly come back. Interestingly it has been found that just sticking a needle into this painful “trigger point” can stop the pain; the anaesthetic isn’t even needed. It seems that anything that can disrupt the pain responses may work.
For all types of spinal injection, some patients report relief after just one injection but repeated injections over time may be required. Spinal injections are usually given in hospital on an out-patient basis. Any invasive treatment, no matter how trivial, carries the risk of complications, and spinal injections are no exception. They should be used only in special circumstances and after careful consultation with your doctor.
Lumbar supports and back belts
Lumbar supports are sometimes prescribed to control back pain. They come in various types. One is a rigid “chair back” brace worn under clothing next to the skin to support the spine. While they can be used as part of non-operative care they are also prescribed by surgeons to judge the effect of immobilizing the spine before a proposed spinal fusion or after spine surgery to protect the back during healing.
The use of back belts is more common. They are semi-rigid supports (like an old fashioned corset) designed to “protect” the spine during activity. They are put on over the clothes and taken off when the job is done. Although wearing a back belt can reduce pain, some experts discourage their use, believing that the belts can give wearers a false sense of security, especially if they are doing a lot of heavy lifting. There’s also concern that continuous prolonged use of any artificial supports like belts or braces can weaken the muscles that support the back and that this can increase the chance of future pain.
Interestingly all the studies have shown that neither a rigid brace nor a soft belt actually stop the spine from moving. The pain relief must come from something else.
The health care practitioner uses the hands to put additional pressure on the back and increase the range of a back movement beyond what the patient can do alone. This is an exaggerated form of mechanical movement and like all physical treatments for mechanical back pain this treatment may give you relief.
Back pain is magnified by tension in the muscles surrounding your spine. Emotional stress can also cause added tension. Massage therapy is aimed at decreasing muscle tension thereby reducing the pain. The technique does not alter the underlying mechanical problem but it often gives temporary pain relief. It is best administered by a Registered Massage Therapist (RMT) who can provide the right type of muscle massage.
If your back and leg symptoms are disabling you can face significant mental and/or emotional stress and your doctor may refer you for psychological support. It’s not unusual for people to respond negatively to this suggestion. They may think their care provider is saying that the pain isn’t real or that “it’s all in my head.” This kind of interpretation can be upsetting, especially if a suggestion intended to be helpful isn’t communicated properly.
The goal of psychological support is to help people cope better with the pain and the resulting disability, whiich causes anxiety, depression, feelings of helplessness, work-related problems, and family stress. Talking to a qualified therapist is often combined with a supervised exercise program to increase physical tolerance. This combination has proven very effective for patients with a complex pain disorder.
Complex pain is not common but it can be extremely destructive. (see Pierre’s Story: Pain Disorder). The condition has only recently been more fully understood and remains a focus of research.
Radiofrequency ablation of the facet joint
This procedure (also called a neurotomy) involves using a needle to deliver destructive energy to the nerves supplying the facet joints—the pairs of small joints the link the vertebrae in your spine. The energy creates damage designed to kill the nerves (ablation) and interrupt the pain signals. The procedure, which is usually done in hospital under X-ray guidance, carries a small risk – as do all invasive treatments – and should only be done in patients with back pain that can be proven to arise from the facets. Even if the procedure works the nerves can re-grow and the pain can return.
Many people use heat (heating pads or hot ‘bags’) or cold (ice packs) or topical liniments and creams for short-term relief from back pain. These treatments are easily accessible and can be used in the home or the workplace. These applications have no direct effect on the underlying structures in the spine but they may disrupt the body’s pain-reporting system and can temporarily stop the pain. They are inexpensive, simply administered and frequently effective.
Traction is an age-old treatment for back pain. The idea is that pulling on the pelvis while stabilizing the rib cage (the patient often wears a halter and belt securing the chest and pelvis) will stretch the lower spine and increase the distance between the vertebrae. That is supposed to pull the discs into line or even increase their nutrition. In reality, the strength of the lower spine is so great that the amount of traction needed to pull the bones apart is far greater than what the patient could tolerate. Traction on the lumbar spine, whether done manually by the practitioner, mechanically with pulleys and weights or with a computer controlled machine, does not pull anything apart. But all these types of traction, like so many other treatments for low back pain, may relieve symptoms for some people some time. It might be the resting position, the effect of tension on the spinal muscles or the placebo effect but it is not stretching the discs
Transcutaneous Nerve Stimulation (TENS)
TENS involves using a small professionally administered device that sends painless, low-voltage electrical current through the skin via electrodes placed above the source of pain. The electricity is thought to disrupt the pain reporting system, ‘scrambling’ normal pain signals to the brain. The effect seems helpful with a small group of patients who suffer a particular type of pain arising in the nerves themselves (called neuropathic pain). It has not been shown to be much help with common mechanical back pain