The first step after a back injury is to get evaluated by a doctor or neurologist, says Shaheen E. Lakhan, MD, PhD, FAAN, a neurologist and pain medicine specialist in Boston. “Physicians can make sure nothing serious—such as evidence of spinal cord compression, rapidly progressing nerve dysfunction, or impending neurologic injury from a tumor, bleed, or fracture—is the cause of your pain, and then offer holistic options for managing it.”
People with neck or back pain often believe they should take it easy, but a robust body of evidence suggests just the opposite: Strength training, physical activity, and education aimed at reducing fear of injury are the most effective prevention and management tools. Experts recommend a multidisciplinary approach that includes these strategies.
Education. Pain can be frightening and make people afraid to move, which creates a vicious cycle of chronic pain and disability. A good understanding of the types of pain, pain thresholds, and the interplay of emotion and pain allows people to manage their own pain better, says Ligia V. Onofrei, MD, assistant professor of neuromuscular medicine at the University of Utah in Salt Lake City. Your neurologist can provide that information or steer you toward programs and resources that can help, including cognitive behavioral therapy. Understanding their pain helps patients stay calm during spasms. It also encourages them to identify possible triggers—such as driving, air travel, or certain repetitive movements or postures—so they can be avoided or minimized.
Physical therapy. A physical therapist will help you address the source of your pain through exercises that strengthen muscles and reduce inflammation. Sessions may include stretching, repetitive movements, thermal ultrasound, and even water-based therapy. “Good physical therapists will give you homework,” says Dr. Onofrei. “The most important therapy is what you do at home, because it takes time to strengthen muscles.”
Exercise. Walk regularly and do gentle exercises to strengthen the back. Start with floor movements such as supine and hands-and-knees yoga poses. Consider low-impact activities such as swimming, water aerobics, yoga, tai chi, and cycling. And limit sitting. Set a timer to be sure you stand and stretch throughout the day.
Experts say yoga can be beneficial for people with neurologic conditions. Learn how yoga can ease pain and improve mobility.
Massage therapy. Regular deep-tissue massage, especially focused on releasing myofascial tissue (muscle knots), can be effective, says Dr. Lakhan.
Heat/ice. Applying heat increases blood flow; cold slows blood flow and reduces swelling, says Dr. Lakhan. Alternating between the two is sometimes most effective. (Whether using heat or ice, be careful not to leave either on too long, to avoid damaging the skin.)
Acupuncture. This Eastern practice, which is believed to stimulate the central nervous system, may be an effective treatment for various types of chronic pain, says Dr. Lakhan. If you fear needles, try acupressure or electrical nerve stimulation; both alternatives focus on the same points on the body.
Safe, targeted prescription medications. If your pain persists despite nondrug therapies, your doctor may prescribe targeted pain medication or nonsteroidal anti-inflammatory drugs that address muscle and nerve pain and inflammation, says Dr. Onofrei. “Muscle relaxers don't have great evidence to back them up,” she says. “But in practice, they may be prescribed for the short term if they don't cause side effects.”
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