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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.

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

Exercises can strengthen and stretch muscles that support the spine. Physical therapy also helps reduce pain, improve movement and help prevent future back problems. 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

Conservative therapy for back pain

Since back pain is often influenced by problems elsewhere in the musculoskeletal system, we’ll determine the root cause and devise an individualized treatment plan that both relieves the pain and addresses the contributing factors.

First Visit

Your initial visit of 45-to-60 minutes will include a health history, an exam, evaluation, and some treatment.

The first step is to get a thorough history of your back pain. Has your back just been hurting and getting progressively worse over time, or was it triggered by some kind of event or injury?

Back pain is often driven by the spine trying to compensate for deficiencies in other areas of the body. A golfer with limited hip rotation, for example, will compensate with more back rotation, causing lower back pain. Someone with poor posture may excessively arch their lower back to sit up taller, causing lower back pain. We’ll put you through a full movement screening and examination to see how you move and determine what movements hurt and what seemingly unrelated influences may be impacting your spine/back health.

Next Steps

Once the root cause or stressors have been identified, we’ll work with you to relieve the pain and fix the dysfunction that is causing the problem. This is where the expertise of our therapists comes into play; your therapist will modify your movements to help eliminate the pain, and recommend exercises that are appropriate for your diagnosis and goals.

Your therapist will work with you in our outpatient clinic 1-to-2 times a week. You will also get a home exercise program, which will increase in complexity as your rehabilitation progresses.

Why EvergreenHealth Rehabilitation Services?

While you can find suggestions and exercises to relieve back pain in health magazines and on the Internet, it takes the expertise of a trained physical therapist to get to the root of the problem causing your pain. A physical therapist will also know which exercises are most beneficial for you, your unique physiology and the nature of your problem.

The diversity of our staff also means we can handle any and all causes of your pain. If a more complex orthopedic problem or neurologic issue is feeding into your back pain, we can consult with staff who are experts in those areas, including referrals for pain-blocking injections or surgery.