What is a good conservative treatment modality for lumbar (lower back) stiffness?

From the Guidelines

Spinal manipulation is a recommended conservative treatment modality for lower back stiffness, as it has been associated with small to moderate short-term benefits for acute low back pain. According to the American College of Physicians and the American Pain Society, spinal manipulation administered by providers with appropriate training is a viable option for patients who do not improve with self-care options 1.

Key Considerations

• For acute low back pain, spinal manipulation is associated with small to moderate short-term benefits 1.
• Supervised exercise therapy and home exercise regimens are not effective for acute low back pain, and the optimal time to start exercise therapy after the onset of symptoms is unclear 1.
• Other nonpharmacologic treatments, such as intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, may be considered for chronic or subacute low back pain 1.

Treatment Approach

A comprehensive treatment plan for lower back stiffness may include:

• Spinal manipulation for acute low back pain
• Intensive interdisciplinary rehabilitation for subacute low back pain
• Exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic low back pain
• Maintaining proper posture, using ergonomic furniture, and taking regular movement breaks to prevent worsening stiffness

Important Notes

• Systemic corticosteroids are not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo 1.
• Patient expectations of benefit from a treatment should be considered in choosing interventions, as they seem to influence outcomes 1.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living Cyclobenzaprine hydrochloride tablets should be used only for short periods (up to two or three weeks) because adequate evidence of effectiveness for more prolonged use is not available and because muscle spasm associated with acute, painful musculoskeletal conditions is generally of short duration and specific therapy for longer periods is seldom warranted

A good conservative treatment modality for lower back stiffness is cyclobenzaprine as an adjunct to rest and physical therapy. The treatment should be used for short periods (up to two or three weeks) to relieve muscle spasm and its associated signs and symptoms, such as pain, tenderness, limitation of motion, and restriction in activities of daily living 2 2.

• Key points:
  • Use cyclobenzaprine for short periods (up to two or three weeks)
  • Adjunct to rest and physical therapy
  • Relief of muscle spasm and associated signs and symptoms
  • Not recommended for prolonged use or for treatment of spasticity associated with cerebral or spinal cord disease.

From the Research

Conservative Treatment Modalities for Lower Back Stiffness

• Conservative management of low back pain includes patient education, therapeutic exercises, and bracing 3
• Instruction in exercise and body mechanics, the use of back supports, and job modifications are documented conservative treatments for spondylolisthesis 4
• Strengthening of the abdominals and paraspinal muscles, especially in the thoracic area, as well as occupational modifications and instruction in body mechanics, deep-heat therapy, and avoidance of maximal forward flexion of the lumbar spine are recommended 4

Exercise Programs for Lower Back Stiffness

• A flexion exercise program consisting of abdominal curl-ups, posterior pelvic tilts, and seated trunk flexion has been found to be effective in reducing pain and improving outcomes in patients with symptomatic spondylolisthesis 4
• Patients treated with a flexion exercise program were less likely to require the use of back supports, require job modification, or limit their activities because of pain 4

Medications for Lower Back Stiffness

• Over-the-counter analgesics, such as NSAIDs and acetaminophen, are commonly used to treat low back pain 5
• Current guidelines indicate that over-the-counter medications should be the first prescribed treatment for non-specific low back pain 5
• However, adding acetaminophen to ibuprofen does not improve outcomes within 1 week in patients with acute, nontraumatic, nonradicular low back pain 6