How to Treat Back Pain Without Surgery

A spine specialist explains how non-operative treatments might be the right choice for treating back pain.

Back pain is one of the most common causes of primary care and emergency department visits in the United States. In some cases, surgery is necessary to treat the pain. Often, though, more conservative treatments, including physical therapy, injections, and core strengthening exercises, can be just as effective in restoring a person’s function and mobility.

Dr. Samantha Erosa

Dr. Samantha Erosa

“There are many different ways to manage common back pain without surgery,” says Dr. Samantha Erosa, an Interventional Spine and Pain specialist with Och Spine at NewYork-Presbyterian. “Most people will experience back pain at some point in their life, and very often it can be cyclical, with periodic flare-ups. But ultimately, with rest and exercise, it can get better without the need for surgery. Physical therapy works well from the neck all the way down to the toes.”

Dr. Erosa shares with Health Matters the steps someone with back pain could take to alleviate pain without surgery — as well as when surgery might be their best choice.

1. Get an Examination

Many patients fall into one of two categories, according to Dr. Erosa. Some experience sudden, severe pain. Others may have transient pain for a while, but begin to notice the pain is more frequent or consistent. In both cases, the first steps are both a physical and a neurological exam.

“The physical exam helps us see what the patient’s strengths are, what their weaknesses are, look at the structure of their spine, and look at their posture in an effort to pinpoint and isolate the weak areas that need to be strengthened,” she says. “We will also check to see if everything is neurologically intact, and that there are no signs of nerve damage.”

2. Identify the Issue

There are many causes of back pain that can be successfully treated without surgery. “Strains and sprains; arthritis; a herniated disc; spinal stenosis, where the space around the spinal cord is too narrow; or radiculopathy, when something is pressing on a nerve in the spine are all conditions where physical therapy can help make gains in relieving pressure and providing pain relief,” says Dr. Erosa.

An exam includes testing sensations along different nerve pathways to see where the pain or the tingling sensations are originating. An exam may be accompanied with imaging, such as X-rays or an MRI. “All of this can help identify what nerves in the back might be involved, or what condition, or conditions, might be affecting you,” she says.

When Surgery May Be Necessary

During the examination with a nonoperative spine specialist, the doctor will check to see if everything is neurologically intact. If the back pain is associated with any of the following red flags, the doctor may want to involve a surgeon right away. These can be signs of more serious problems, and your doctor would want to intervene sooner to make sure these problems don’t progress or become permanent.

  • Numbness where a patient cannot feel the doctor touching an extremity
  • Severe weakness in the lower body
  • Bowel or bladder problems
  • Traumatic injuries caused by a fall or an accident
  • Sexual dysfunction

3. Prepare to Exercise

If a patient has significant pain that’s limiting them from moving and doing exercise, the first step might be an injection of anti-inflammatory and/or pain-relieving medication. “There are different types of injections we could use,” says Dr. Erosa. “An epidural steroid injection, for instance, helps to reduce irritation and inflammation around spinal nerves, while a facet joint injection is meant to diagnose and/or treat pain related to arthritis of the spine. Either way, we’ll use this targeted approach to help reduce the symptoms enough so the person can manage their pain, and then monitor the patient’s progress now that the injection allows them to do the physical therapy.”

4. Start Moving

Exercise and physical therapy help to restabilize the spine and, ideally, take pressure off some of the areas where the pain is originating. For instance, if someone has a herniated disk, where a disk in the spine is touching a nerve, physical therapy will strengthen the muscles around the disk and increase the support of the spine while alleviating some of the pressure points. “Exercise won’t necessarily help the disk move back to its original spot, but strengthening your core and restabilizing your spine can help your symptoms improve,” says Dr. Erosa.

5. Stick With Your Plan

The goal of physical therapy for back issues is to strengthen the core muscles, as well as the muscles in the buttocks and pelvis to support the spine. When those muscles are stronger, it helps take pressure off the areas that may be causing pain. “If patients stick with it, we will often see gains in mobility and pain reduction,” says Dr. Erosa. “Think of exercise as a pill that you have to take every day for your lower back or spine health. It’s not as easy as a pill, but if you keep up with your exercise regimen you’ll have a better chance of preventing not only the pain, but also the progression of whatever is causing problems in the first place.”

6. Try Different Exercises

There are plenty of gentle exercises patients can do that are both enjoyable and can help with flexibility and strength. “If a patient wants to do more than the exercises provided by the physical therapist, they can also try aerobics, yoga, Pilates, or tai chi,” suggests Dr. Erosa. “Those are great ways to maintain flexibility and strengthen the core and lower back, and they offer a way to socially engage while exercising. We only caution that patients tell their physical therapist and listen to their body and not push themselves to where they exacerbate the problem.”

Outside of exercises, there is evidence that alternative methods such as massage therapy, acupuncture, and mindfulness-based stress reduction can also help in relieving low back pain.

7. Be Mindful of Posture and Routine Movements

In addition to exercise or physical therapy, learn from your physical therapist the proper way to do the things you might do every day, like maintaining good posture or bending down to pick things up. “Poor posture can place a great amount of stress on the back and neck, so while engaging your core and keeping up with exercises is good, you should also be mindful of how you are moving your body,” says Dr. Erosa.

8. Stay in Close Touch With Your Doctor

If you’ve seen someone for conservative treatment of back pain and it’s not improving — for instance if mobility isn’t improving or there’s more stenosis — the person may be a candidate for surgery. “At that point we’ll consult a surgical colleague from Och Spine at NewYork-Presbyterian to get their perspective,” says Dr. Erosa. “The nonoperative specialists have a highly collaborative relationship with the spine surgeons at Och Spine. The patient may not want surgery, but hearing from a surgeon can be informative and give an idea of alternative options if medications, injections, or exercises aren’t working.”

Samantha Erosa, M.D., is a non-operative Interventional Spine and Pain specialist with Och Spine at NewYork-Presbyterian and an Assistant Arofessor of Rehabilitation and Regenerative Medicine at Columbia University Vagelos College of Physicians and Surgeons. She is dual board-certified in Pain Medicine and Physical Medicine and Rehabilitation and specializes in interventional approaches to treat pain related to the spine and musculoskeletal conditions. 

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