Non-Surgical Management of Low Back Pain

Back pain accounts for over 50 percent of all physician office visits. The options for treating back pain have historically been poorly understood by patients, many who feared that surgery was the only solution to cure their pain. Luckily, treating back pain is much easier today thanks to an abundance of new diagnostic and, non-surgical and therapeutic techniques.

Back injuries can result from a variety of causes. The most common sources of back pain, however, are either muscular or those involving the intervertebral discs. These typically involve inflammation around a disc with associated disc protrusion and/or muscle spasms.

Zeroing-in on the Problem

A variety of diagnostic tests are available to determine the scope and severity of the back injury. These include X-ray, MRI, CT Scan, Electrodiagnostic testing (EMG/NCS) and Discography (a procedure to determine whether a particular disc in the spine is causing back pain).  Once a definitive diagnosis is made, non-surgical treatment is implemented.

The approach to treating low back pain is direct, and the focus is on non-operative methods.  Initially, medication such as anti-inflammatory medicines or muscle relaxants are prescribed.  Sometimes, the pain warrants use of a mild narcotic analgesic medication to help with discomfort.

Often physical therapy is instituted after two days of inactivity or rest. Treatment centers on initial passive modalities with progression to a back muscle strengthening program.

If the pain does not initially improve with medications and physical therapy, a variety of lumbar injections can be considered.  These may include epidural steroid injections, facet injections, or local trigger points and joint injections.  Most patients recover from their back injury thanks to a combination of these medications and therapy and go on to lead productive lives without significant recurrence of pain.

Next Steps for Chronic Sufferers

In some cases, however, patients may continue to have pain. There are now several new procedures available, which are minimally invasive and have been shown to provide long-term pain resolution with healing of the involved disc. A discogram, for example may show a lesion in one of the intervertebral discs. IntraDiscalElectroThermal (IDET) Therapy is a relatively new procedure where a catheter is placed into the disc and the disc is subsequently heated to 90 degrees. This facilitates healing of the disc and the regeneration of normal tissue.

Another minimally-invasive procedure is known as Percutaneous Disc Decompression. The procedure involves removing a small portion of the painful and abnormal part of the disc. Again, this procedure is minimally invasive. The disc then heals and the patient experiences diminishing lower back pain.  Both procedures have been highly effective in eliminating the need for many back surgeries.

Back pain is very common and is a frequent cause of disability in our country.  Utilizing the latest non-surgical methods available, including medications, therapy, injections, and new minimally invasive spinal procedures, most patients get significant relief from pain or even fully recover without the need for low back surgery.

To obtain additional information on these two procedures, please visit the Non-Surgical Orthopaedics web site at and

Video has a great short video on back pain diagnoses here:

Dr. Weil is the founder and CEO of Non-Surgical Orthopaedics, P.C., which provides the latest non-invasive treatment for low back and neck pain.  The practice has three locations throughout metro Atlanta, with offices in Marietta Canton, and Carrollton.  Please visit our website at

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