When do you recommend considering surgery?
Conditions such as infection, cancer, trauma or severe scoliosis often require surgical treatment. But disk herniation is another matter. Not every disk that ruptures requires surgery, and many patients get better without an operation. If, however, the herniated material from the disk presses on a nerve root that governs strength and sensation in the foot or leg, bladder or bowel control, Dr.Rao may recommend surgery when other treatment is not effective. Also if you feel that your treatment is not allowing you to return satisfactorily to your usual lifestyle, or if you are facing social, personal or work related situations which demand an early return to normal function, you may wish to consider surgical treatment of your problem. Allowing the disk material to continue pressing on the nerve root in these circumstances may lead to permanent damage. This type of surgery [microdiskectomy] has a success rate of 90-95%. Often, it can be done with a minimally invasive approach that requires just a few-week recovery. Please do talk to Dr.Rao about it.

Will my pain go away without surgery?
Sometimes there is what we call a "mechanical" reason for back pain. For example, arthritis can cause bony overgrowths on the spine that narrow the passageway for various nerve roots exiting the spinal cord, causing pain.

Degenerative disk changes, a common condition as we age, can also cause mechanical pain. As the material of the disk wears down, other structures in the back may shift in response to the changed anatomy and be more cramped. Muscles may go into spasm to protect the affected portion of the spine. A portion of the inner disk, the nucleus, may bulge out and press on a nerve root, causing pain.

These problems will need a longer time to recover and you must be vigilant about avoiding future episodes. Recurrence is common, but the McKenzie exercises can be done prophylactically for just a few minutes a day to keep recurrence at a minimum.

How can you tell when there is a problem more serious than a muscular strain or sprain?
If you don't get better - or worsen - despite the combination of initial rest, exercises and medication, Dr.Rao may consider doing imaging scans. Magnetic resonance (MR) and computed tomography (CT) are excellent procedures for viewing the spine, since they show soft tissues as well as bone. Conditions that may show up include disk herniation (bulging) or degeneration, spinal stenosis (narrowing of the spinal canal), arthritis, or nerve root compression. Rarely, spinal infection or tumor will be seen.

Are there other treatments which are effective?
Dr.Rao sometimes recommends an epidural injection of a corticosteroid. Steroids are powerful anti-inflammatories, so such injections can help relieve pain by alleviating swelling. This is an especially useful therapy when the problem is in soft tissue, meaning a muscle, ligament or disk. It is less likely to be helpful for people with arthritic changes or pinching and narrowing due to disk degeneration and bony spurs. A real benefit of steroid injection is that it can decrease the pain long enough to give you a chance to begin a strengthening exercise program.

What about seeing a chiropractor?
Chiropractors often provide relief of acute back pain. If you do not have weakness or loss of feeling in your arm or leg, and have no accidents with your urine or stool function, you may try chiropractic treatment. Chiropractic is not recommended for fractures, infection or cancer, so be sure of your diagnosis before scheduling an appointment.

Is massage safe?
Massage feels wonderful. It certainly won't cure you, but if it makes you feel good and you can afford it, Dr.Rao generally says "Go for it!" Anything that relaxes the muscles can help you relieve pain.

How do you feel about acupuncture?
Acupuncture for low back pain is being increasingly accepted in Western medicine, and Dr.Rao sometimes prescribes it when other methods have failed to bring adequate relief.

Another useful treatment is transcutaneous electrical nerve stimulation, or TENS. Tiny charges of electricity are delivered to electrodes attached to the lower back. The current stimulates the spinal cord and relieves pain. A newer version of this therapy call percutaneous electrical nerve stimulation (PENS), delivers the electric charges to tiny needles that are actually inserted in the lower back.