Long-Term Relief for Lower-Back Pain

Few treatment options provide long-term relief to people suffering from back pain, one of the most common causes of disability in modern societies. Fortunately, reports the British Medical Journal, lessons in posture exercises known as “the Alexander technique,” may help people develop good stationary posture and body movement skills—and it can lead to lasting benefits for back pain sufferers.

The Alexander technique is different from therapies such as spinal manipulation, massage, and conventional physical therapy. Its teachers provide continuous assessment of a person’s patterns of muscle use and tension, particularly in the head, neck, and spinal regions, and give feedback via verbal instruction and hand contact to develop proper muscle use and encourage release of muscle tension. Students are instructed in how to practice the technique at home.

Comparing back therapies

In the new study, 579 people with chronic or recurrent low back pain were randomly assigned to one of four treatment groups:

• normal care,

• therapeutic massage once per week for six weeks,

• a series of 6 Alexander technique lessons: twice per week for two weeks, then once per week for two weeks,

• or a series of 24 Alexander technique lessons (22 in the first five months, then once at seven months and once at nine months).

Half of each group was additionally assigned to receive an aerobic exercise prescription from a general practitioner followed by up to three sessions of behavioral counseling by a nurse.

Alexander technique has lasting benefits

After three months of treatment, measures of disability and pain improved in all of the groups except the normal care group; however, after one year, only those in the Alexander technique groups maintained these improvements. The people who received 6 lessons had a 17% improvement in disability scores and a 48% reduction in number of days in pain, and those who had 24 lessons experienced a 42% decrease in disability and an 86% decrease in pain compared with normal care. Adding the exercise prescription led to an improvement in the 6-lesson group that was similar to that seen in the 24-lesson group.

“Previous studies have shown that therapeutic massage is effective for relieving chronic back pain over the short term, but our findings suggest that these benefits are lost over time, perhaps because massage provides no long-term educational element,” said lead study author Dr. Paul Little at the University of Southampton in the United Kingdom. “In contrast, lessons in the Alexander technique lead to the development of increased patient awareness and long-term posture and body movement habits that provide long term improvement in back pain.”

Basic back care

In addition to learning the Alexander techniques, people prone to back pain can take the following steps to protect their backs:

• Get regular exercise and think about enrolling in a therapeutic exercise class. (Supervised exercise programs tend to lead to longer lasting habit changes.) Consult your doctor before starting an exercise program for the first time or increasing your activity level dramatically.

• Follow the basic principles of proper lifting and always wear low-heeled comfortable shoes.

• Make sure your low back is supported when sitting or driving for extended periods, and rest one foot on a low stool when standing for long periods.

March 12, 2009

(BMJ 2008;337:a2656)

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, VT, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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