Chiropractic treatment: Even when the pain is in the lower back, the problem tends to be with the entire spine, says Victor Meir Nazarian, a Los Angeles–based chiropractor. Chiropractors employ manipulation—adjustment of the vertebrae— to help align a patient's spine, and often prescribe regular visits. "People come in only when they're in pain," Nazarian says. "But we need to think of our spine the way we do our teeth, using preventive care to stay healthy."
Physical therapy: The lower back must flex, extend, and rotate, says physical therapist Peggy Brill, author of two books on managing pain through exercise. Yet most of us sit immobile for hours at a time. That's why physical therapists prescribe walking and other gentle exercise, such as stretching and core strengthening, following a flare-up of back pain. Usually, after 72 hours patients will begin to feel better, says Brill.
Stress relief: Stress is the source of most low back pain, according to John Sarno, MD, professor of clinical rehabilitation medicine at New York University. Though Sarno doesn't dispute that the pain is real, he believes it stems from buried emotional issues that trigger tension in the body and ultimately deprive nerves and muscles of oxygen; relief comes through understanding this link and by learning to deal with negative emotions constructively.
Surgery: "Think of this as the last resort," says Paul McCormick, MD, a professor of neurological surgery at Columbia University. Surgery may be necessary in some cases of curvature of the spine, narrowing of the cavity that surrounds spinal nerves, and nerve inflammation or disk degeneration—but these conditions are rare, McCormick says: "Ninety-nine out of one hundred patients will recover without surgery."
My Recommendation: The research is positive on chiropractic treatment, physical therapy, and stress relief—they all help ease back pain. (As Paul McCormick says, with rare exceptions, surgery is unnecessary.) The key is to get moving again as soon as possible after the pain hits, and then make sure you take steps to prevent a return. I see low back pain as a warning about overall fitness: If you're active, your hips and back are flexible, your core strength is good, and you're coping well with the emotional challenges in your life, your back probably won't bother you. Overlook one of those areas, however, and your back will let you know. And while the emotional link to back pain is controversial, there's no question that stress can play a part in muscle tension, especially in the lower back and hips, leading to trouble.
Read another column by Dr. Oz: 4 treatments for a common but hard to diagnose disease