Passive treatments for chronic back pain: Acupuncture, electrotherapy and manual therapy

Acupuncture is a traditional Chinese medicine treatment that involves inserting thin needles into specific points on the skin. According to traditional beliefs, the needles influence the flow of energy through the body when they are placed at certain points along the energy pathways (meridians). This is thought to activate the body’s own healing powers. But there's no scientific proof that these energy pathways exist. Research has shown that it doesn't matter where exactly you insert the needles and whether they actually enter the skin or not. For example, traditional Chinese acupuncture hardly worked any better than "sham" (fake) acupuncture, where the needles were inserted in the wrong places.

Inserting the acupuncture needles sometimes causes minor bleeding or bruising, especially in people who are taking anticoagulant medication (to prevent blood clots). To avoid infection, it's important to use sterile disposable needles. The risk of serious side effects is low.

Transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS) are types of electrotherapy. In these treatments, special equipment is used to trigger electrical impulses in the nervous system. This is done to stop pain signals being sent to the brain and to stimulate the production of endorphins (the body's own pain-relieving hormones). TENS involves placing electrodes on the skin to send electrical impulses through the skin (transcutaneously). In PENS, the electrical impulses are sent through acupuncture needles inserted into the skin (percutaneously). Inferential current therapy is another technique that works in a similar way to TENS.

There is no scientific proof that electrotherapy can relieve chronic back pain. Previous studies in this area were not very conclusive and only looked at the effect over a short period of time. In PENS, the small punctures in the skin may lead to minor bleeding or an infection.

Mobilization and manipulation are two types of manual therapy. In mobilization, the therapist slowly moves the joint within its normal range of movement. Manipulation therapy, on the other hand, involves using short, sharp movements to push a joint beyond its normal range of movement.

Popping or cracking sounds may be heard during the procedure. These sounds occur when small bubbles of gas in the joints burst, just like when people crack their knuckles. It is not exactly clear how these approaches are meant to work. Some of the current theories involve the release of muscle tension, the "unsticking" of tissue that is stuck together, and the re-alignment of certain joint structures.

There are only a few studies on the manipulation and mobilization of the spine for the treatment of chronic back pain. Further research is needed in order to properly assess the effectiveness of these treatments.

Manual therapy can sometimes lead to side effects such as muscle soreness and cramps, as well as short-term joint stiffness or temporary pain. More serious complications of joint manipulation, such as bone fractures or signs of paralysis, are very rare. They could occur if, for instance, someone has osteoporosis or if the manipulation leads to a slipped disc or makes an existing slipped disc worse.

Massages are a traditional treatment for back pain. They are meant to relax your muscles, reduce painful muscle tension, and increase your general sense of wellbeing.

There are different types of massage. Common techniques include traditional (Swedish) massage, Thai massage, and acupressure. The methods differ in terms of the type of hand movements that are used and which parts of the body are massaged. They also vary in the amount of pressure applied, and whether the massage therapist uses their hands, fingertips or special tools.

There is a lack of good-quality research on the effects of massage in the treatment of chronic back pain. It seems that massage can temporarily relieve the pain, but there is no proof of a longer-term effect.

Depending on how much pressure is applied to the affected area, the massage might be painful or you might feel sore shortly afterwards. Some people are allergic to massage oil, which can cause things like rashes.

Osteopathy is a type of alternative treatment. It is based on the idea that all of the body's structures and functions influence each other. This means, for example, that problems and diseases in one joint or organ are thought to have an effect on other parts of the body. Connective tissue is considered to be particularly important in osteopathy because it connects the body's different physical structures and organs. There is no scientific proof that this theory is true, though.

In osteopathy, therapists use nothing but their hands when performing physical examinations and treatments. The therapist first feels for areas that you can't move very well, hard tissue, tension in the body, and other kinds of changes in the tissue. Then they apply various stretching techniques, massage approaches and hand movements to help with these problems. One type of osteopathic treatments are known as "muscle energy techniques." The aim of these approaches is to release areas of physical tension by tensing the muscles and stretching them. Research on osteopathic treatments for back pain have produced contradictory results. There is no proof that muscle energy techniques work.

In Germany, the job title "osteopath" isn't protected and doesn't require specific training.

A wide range of other treatments are offered for back pain, including traction therapy, kinesiology tape, short-wave diathermy, laser therapy, electromagnetic therapy and ultrasound therapy. There is no scientific proof that these and similar treatment approaches can help to reduce back pain.

When it comes to most of the complementary or alternative medicine approaches, there is no scientifically plausible explanation for how they might work either. The claimed mechanisms of action often contradict the basic principles of science.