Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Other physical treatments

It consists of the application of local heat, cold, massages or short wave diathermy, ultrasounds, magnetotherapy or laser.

Objective

To improve pain

Theoretical base

Although there are routinely used procedures, there are no studies that either prove their efficacy in back pain -see below- or that precisely define how the effect is obtained.

Vessel dilation is an essential aspect of inflammation,so that application of cold could be beneficial for contracting vessels.

It is assumed that muscle contraction negatively affects blood circulation to the muscle, which increases pain. In those cases where this could be an important factor, such as in chronic cases, heat is considered to be beneficial, since it tends to dilate vessels and improve blood circulation. On this basis, massage application is also considered to have a beneficial effect by stretching contracted muscles.

Basically, short wave diathermy and laser produce a more penetrating heat effet on a specific point - not on an area-, reaching deeper tissues. But this does not necessarily mean that back pain is improved.

Some laboratory studies suggest that laser may increase the degree of cell activity, although it remains to be defined how this effect can produce back pain improvement.

Also, none of these theories on the empirical basis of physiotherapy would explain the potential effect of these procedures beyond the time of application.

Evidence of efficacy

The existing recommendations based on scientific evidence establish that, despite the fact that this type of treatment is widely used, it has not proven to be effective in treating back pain.

Indications

The existing recommendations based on scientific evidence establish that there is no scientific evidence to prescribe any of these treatments, and therefore do not recommend them. Some of those recommendations suggest that if a patient requests physical therapy, the physician may advise self-application of heat or cold, at home, for temporary symptomatic relief.