Unfortunately, guidelines for the referral of patients to physical therapy or spinal manipulation do not differentiate between chiropractic, osteopathy and physical therapy. This lack of a precise, common language may be at the root of continuing disagreements over which type of physical therapy is best for which type of backache. Medical research has not helped to clarify the issue; indeed, researchers may deliberately misuse terms such as "chiropractic" in their research.

While bed rest is the traditional recommendation for back sufferers, the latest research shows that movement is the key to preventing trauma from turning into chronic pain. Try to keep moving, within the limits of your level of pain. Investigate gentle exercises such a t'ai chi (a form of qigong). In one randomised controlled study, six weeks of t'ai chi significantly reduce the intensity of pain suffered by a group with chronic low back pain, compared with those given routine care. Pain was especially improved during the last week. T'ai chi has only 20 movements which can be taught over a period of eight weeks. Yoga and Alexander Technique may also be beneficial.

Possibly effective treatments:

• Acupuncture
• Biofeedback
• Group education
• Hypnosis
• Least effective treatments:
• Bed rest
• Routine analgesics
• Antidepressants
• Opioid analgesics
• Traction
• Transcutaneous electrical nerve
• stimulation (TENS):
• Corsets
• Trigger point and ligament injections
• Epidural injections

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