Back in the swing

Reaching to pick something up, you immediately feel a big twinge.

It hurts to move. Sitting is even worse.

Your doctor orders rest, pain medicines, hot and cold packs and gradual, stretching exercises. That works 80 percent of the time, pain experts say.

At least 30 million Americans live with chronic back pain. The older, more overweight and out of shape, the greater the chance that pain will persist.

But wait before signing up for back surgery, a big-deal operation that makes matters worse four of 10 times, experts say.

There are options, some new, some less known. Here are four different approaches — from an anesthesiologist, a chiropractor, an orthopedic surgeon specializing in spine disorders, and a physical therapy center.

Multidisciplinary pain center

What it is: Outpatient center that offers traditional, cutting-edge and holistic approaches, many started by interventional anesthesiologists who perform a wide range of pain procedures.

What it offers: Spinal injections; surgically implanted pain pumps and spinal cord stimulators; noninvasive disc procedures; acupuncture and naturopathic medicine.

Three common procedures:

• Epidural injections: Injections of steroid medicine into the back to numb back and leg pain. A series of three injections typically helps 60 percent to 70 percent of patients, according to Dr. Louis Bojorab, a physician at Michigan Pain Specialists. “A lot of people have the mistaken idea they only can get three” injections but patients can undergo them every three months indefinitely, Bojorab says. Side effects: Injections cause headaches in about 1 percent of patients. Cost: about $400 for a steroid epidural injection in an outpatient center; insurance covers.

• Nucleoplasty: A minimally invasive procedure performed under light sedation for moderate bulging discs that have not torn, or sciatica, a condition often caused by disc pain that radiates down the leg. It typically is offered when epidural injections aren’t successful in reducing pain. Nucleoplasty uses a laser tool, the width of a quarter, inserted inside the disc to vaporize and shrink it. A 20-minute procedure, it may result in soreness afterward and requires two weeks of rest and gradual exercise before returning to full function. Cost: about $4,000, usually covered by insurance. Success/risks: 85 percent of patients reduce pain by at least 50 percent, Bojorab says. Rare risk of infection, bleeding. More information: www.nucleoplasty.com.

• Vertebroplasty: A minimally invasive procedure for compression fractures caused by tumors and osteoporosis. Performed with light sedation, it involves the injection of an acrylic bone cement into a disc when it protrudes outside its center. It can prevent further bone loss but can’t correct stooped posture. Cost: About $3,000, usually covered by insurance.

Success/risks: 92 percent effective long-term in providing pain relief, studies show. Rare risk of bleeding, infection.

More information: www.vertebroplasty.com .

Cox flexion distraction manipulation

What it is: A widely used chiropractic method that provides nonsurgical approaches to back, leg and neck pain.

What they treat: Herniated discs, whiplash, sciatica, or leg pain, and facet syndrome, a condition in which back joints slip out of alignment. “Most people come to us last, when they are scheduled for surgery but hope to avoid it,” says Dr. Ron Manteuffel of Center Line Chiropractic Life Center in Center Line, Mich. “We’re their last resort. We should be their first.”

The approach: Cox flexion uses a table that makes circular and vertical movements to release disc and spine pressures. The movement, guided by a chiropractor by hand, creates a suction effect to allow a disc to return to its normal height or a joint to its normal range of motion. The center couples the approach with nutrition and exercise advice and a tool called the ProAdjuster system that analyzes and treats the spine with gentle electrical pulses. “Sitting down raises the pressure” inside a herniated disc, Manteuffel says. “We tell people to stand up or lie down, but don’t sit,” he says, demonstrating by stretching out his torso on the floor, propped up on his elbows.

Success/risks: Chiropractic manipulation is federally recognized as a successful approach to low-back pain; Cox distraction is well-studied and widely accepted as a valid approach. More than two-thirds of patients report excellent to good improvement with a typical rehabilitation program of 12 visits, studies show. After 12 10-minute treatments, typically over four weeks, doctors refer patients to spine and back physicians if a patient’s pain persists.

Who isn’t a candidate:

Persons with new fractures or dislocations, severe arthritis or osteoporosis.

Costs: $80 a visit.

Insurance: Many cover.

More information and a list of other practitioners: www.coxtechnic.com; 800-441-5571.

Mckenzie method and medx lumbar machine

What it is: A precise type of physical therapy that offers a nonsurgical approach for chronic neck and back pain, using an aggressive regimen of strengthening exercises to restore back function.

What they offer: The McKenzie Method, developed in the 1960s by a New Zealand physical therapist, analyzes whether a person’s pain worsens or improves with precise movements and positions. “If we test different positions, it helps us unravel the mystery of how to manage the pain,” says Ted Dreisinger, director of research and development for Dynamic Rehabilitation Centers in Michigan. These directional preferences are key to successful pain management, Dreisinger says.

MedX is a computerized exercise machine that stabilizes the pelvis while patients work on brief exercises, often no more than 2 minutes a session, to strengthen weak muscles surrounding the spine. It was developed by Arthur Jones, the inventor of Nautilus exercise equipment. “The low back is the weak link in the chain,” Dreisinger says.

The program works to help back patients exercise in a controlled way. “When you are told you have degenerative disc disease, or you are told you can’t lift more than 20 pounds, everything you see weighs 21 pounds and you get into a cycle of deconditioning,” Dreisinger says. “When you strengthen someone in a very controlled environment, they know they can do this much. It helps patients gain confidence to have the freedom to live life again.”

Candidates: People whose pain increases or decreases with various movements and positions.

Who isn’t a candidate: People with recent compression fractures; pregnant women; people with spinal tumors or infections or recent abdominal surgery; or brain deficiency.

How long it takes: A typical rehabilitation program is two weekly sessions for 10-12 weeks. Each session is 20-40 minutes. Patients are regularly evaluated to determine if strength and range of motion are improving.

Success/risks: Gains in strength and range of motion appear in two-thirds of patients without surgery, studies show.

Costs: $2,000-$2,500, or $90-$125 a visit.

Insurance: Varies.

Kyphoplasty

What it is: A minimally invasive surgical procedure for compression fractures, or kyphosis, caused by osteoporosis or spinal tumors. The operation can be repeated for people who develop a second compression fracture, which occurs 15 percent to 20 percent of the time.

Where it is offered: Since kyphoplasty was federally approved in July 1998, nearly 3,000 U.S. doctors have been trained to do the technique. Call 877-459-7466 or visit www.kyphon.com to find a physician who performs the procedure.

How kyphoplasty is performed: After a patient is given intravenous or general anesthesia, doctors make two small incisions in the patient’s back. They insert a thin instrument through the incisions through which a tiny balloon is pushed to the fracture site. Doctors check placement of the device with fluoroscopy, an advanced X-ray machine. Once positioned, the doctor inflates the balloon inside the bone’s spongy center, to get the bone back to its normal height. A cement-like material stabilizes the bone permanently.

How long it takes: 30-45 minutes, though time varies depending on the physician’s skill and the number of fluoroscopes used. Providence uses two to improve and shorten the procedure.

Relief: Often immediate.

Who doesn’t benefit: Those with a compression fracture of more than a year.

Success/risks: Highly safe, successful in reducing pain in 100 patients followed one year. Rare risk of infection and bleeding. It’s not known yet whether kyphoplasty increases the chance of another fracture nearby.

Cost: $4,000-$6,000.

Insurance: Usually covers.