At the Cedars-Sinai Institute for Spinal Disorders, conservative care is the often first course of treatment for those suffering back pain. A combination of non-invasive treatment measures including physical therapy , physiatry , pain management and alternative medicine is used to reduce pain and increase mobility. Conservative care is also used to assist in managing issues frequently associated with back pain, such as sleeplessness or depression. For most people, back pain tends to get better within two weeks to three months regardless of the type of treatment used. In many cases, however, early use of conservative care will speed the healing process. The length of time that conservative treatment will be required varies greatly from patient to patient. That's why our team of spine experts carefully monitors each patient throughout their course of treatment.

• Back Braces
• Chiropractic
• Discography
• Electrotherapy
• Interventional Pain Management
• Intradiscal Electrothermal Annuloplasty (IDET)
• Pain Management
• Physiatry
• Physical Therapy
• Physical Therapy (Active Modalities)
• Physical Therapy (Passive Modalities)
• Stress Management

Limiting the motion of the spine can often enhance the healing process especially in the case of spine fractures or postoperative fusions. Bracing is also used to treat adolescent idiopathic scoliosis, and progressive diseases causing curvature of the spine. When your physician recommends a back brace, generally two types or braces are considered - rigid or corset. Rigid braces are form-fitting plastic braces that can limit approximately 50% of the motion of the spine. And while they are effective, rigid braces are heavy, hot and tend to be uncomfortable. Corset braces, also known as elastic braces, are sometimes recommended to limit motion of the spine after a lumbar fusion. Corset braces are typically made of cotton and nylon materials making them more comfortable to wear and more lightweight. When back braces are needed, it is important that the health care professional providing these services is properly credentialed.

Chiropractic is a branch of the healing arts focused on human health and disease processes. Doctors of Chiropractic are physicians who consider people as an integrated being and give special attention to the physiological and biochemical aspects including structural, spinal, musculoskeletal, neurological, vascular, nutritional, and emotional and environmental relationships.

The practice and procedures which may be employed by Doctors of Chiropractic are based on the academic and clinical training received in and through accredited chiropractic colleges and include, but are not limited to, the use of current diagnostic and therapeutic procedures. Such procedures specifically include the adjustment and manipulation of the articulations and adjacent tissues of the human body, and most specifically the spinal column. Included is the treatment of abnormalities to address functional disorders.

Chiropractic is a drug-free, non-surgical science and does not include pharmaceuticals or surgery. Chiropractic manipulation is one of several established forms of treatment used for back problems. Now, with today's growing emphasis on treatment options, manipulation is receiving much more widespread attention. Chiropractic manipulation, also frequently called the chiropractic adjustment, is the form of manipulation that has been most extensively used by Americans for the last one hundred years. Satisfied chiropractic patients already know that DCs are uniquely trained and experienced in diagnosing back problems and are the doctors most skilled in using manipulation for the treatment of back pain and related disorders (source: American Chiropractic Association).
The Cedars-Sinai Institute for Spinal Disorders provides access to chiropractic care.

Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative care. The most common use of discography is for surgical planning prior to a lumbar fusion. There are also non-surgical interventional pain management techniques that also address back pain.

Electrotherapy can be used effectively to help eliminate back pain and speed the healing process. Some of the more common treatments using mild electrical current include:

Transcutaneous Electrical Nerve Stimulation (TENS) - A TENS unit is a battery-powered device that looks very much like a small Walkman (TM) radio or pager. Through the use of surface electrodes, an electrical current runs from the equipment to the target area emitting a tingling sensation that affects the nerve and muscle cells. The most common use of the TENS device calls for setting the device to deliver 80 to 100 impulses a second for 45 minutes, three times a day. This stimulation enhances healing, alleviates swelling and reduces pain. However, pain is different for everyone. Two people whose pain is caused by the same problem may need very different settings to achieve relief. If the patient experiences substantial pain relief, a TENS unit may be used at home for low back pain relief on a long-term basis.

Interferential Current (IFC) - This form of treatment penetrates the skin more deeply than a regular TENS unit with less user discomfort considering the higher level of concentration. The IFC has been found to provide pain relief for patients who have not been helped by TENS. The IFC unit is more expensive than the TENS units, which may keep some patients from using the device. Interferential current (IFC) is essentially a deeper form of TENS (TENS unit). IFC modulates at a higher frequency (4000 Hz) carrier waveform with the same signal produced by a TENS unit. The higher frequency penetrates the skin more deeply than a regular TENS unit, with less user discomfort for a given level of stimulation. This may block transmission of pain, and could possibly cause the body to release its natural painkillers, endorphins.

Galvanic Stimulation (GS) - Galvanic stimulation is most useful in acute injuries associated with major tissue trauma with bleeding or swelling. Galvanic stimulators apply direct current to the injured area in contrast to TENS and IFC units, which apply alternating current. Through the use of positive and negative pads placed on the skin, direct current creates an electrical field over the treated area, that, theoretically, changes blood flow. The positive pad behaves like ice, causing reduced circulation to the area under the pad and reduction in swelling. The negative pad behaves like heat, causing increased circulation which speeds healing.

Interventional Pain Management uses injections instead of oral pain medications to diminish pain. In addition to its obvious therapeutic benefit, an injection can also play a very important diagnostic role in the identification of the source of pain. Oftentimes an X-ray or MRI scan of the spine uncovers more than one area potentially responsible for creating pain. By selectively injecting each separate area or spine structure with anesthetic solution, we gain the ability to pinpoint the problem. The Interventional Pain Management physician is specially trained to safely perform the following procedures:

Epidural Steroid Injection - The most commonly performed procedure used to relieve pain is the epidural steroid injection. This injection delivers a powerful anti-inflammatory cortisone solution directly into the spine, which diminishes the swelling and irritation surrounding a nerve or a region of the spinal cord. The majority of patients who receive epidurals will experience a beneficial effect, lasting for a number of weeks or months, allowing for continual participation in their rehabilitation program. Epidural injections can be repeated and usually coincide with episodic flare-ups of severe symptoms.

Selective Nerve Root Injection - Another commonly performed injection is the selective nerve root injection. In this procedure, the physician uses X-ray guidance (fluoroscopy) to locate a particular nerve root. The medication is injected into the troubled nerve root, rather than into the entire spine. For diagnostic purposes, the injection is more specifically directed.

Facet Joint Injection - Our spines are made up of vertebral bodies or bones connected to each other by facet joints -- one facet joint pair for each level. Like any joint in the body, arthritic facet joints can cause pain. Injecting medication directly into the facet joint with the aide of x-ray guidance (fluoroscopy) helps to locate the source of the pain and achieve pain relief.

Sacroiliac Joint Injection - At the base of the spine, lies the sacrum, more commonly referred to as the tailbone. The sacroiliac joint serves to connect the sacrum to the pelvis and may also be responsible for producing lower back and leg pain. In such cases, an injection into the sacroiliac joint can provide relief from pain.

If epidural injections do not help with the low back pain, another treatment to consider is Intradiscal Electrothermal Annuloplasty (IDEA, IDET). This technique involves inserting a heated catheter in the nucleus pulposus of a vertebra.

A specialized field that combines physical medicine and rehabilitation is known as physiatry. The focus of this specialty is on treating acute and chronic pain and musculoskeletal disorders while restoring function. The physiatrist is a physician who treats a wide range of problems from sore shoulders to spinal cord injuries. Physiatrists at the Cedars-Sinai Institute for Spinal Disorders offer a broad range of medical services. They do not perform surgery, but may prescribe medications or assistive devices, such as back braces. They also use diverse therapies such as interventional pain management, heat and cold packs, electrotherapies, massage, biofeedback, traction and therapeutic exercise to eliminate back pain and promote healing.

At Cedars-Sinai, we believe physical therapy plays an important role in the rehabilitation of individuals suffering from acute or chronic back pain. Specially trained physical therapists at the Institute use a combination of passive physical therapy and active physical therapy (exercise) to provide pain relief and increase function.

The Outpatient Rehabilitation Center at Cedars-Sinai Institute for Spinal Disorders is a center with a full range of state-of-the-art equipment dedicated to providing comprehensive physical therapy programs for surgical and non-surgical patients. Rehabilitation services are provided by a dedicated physical therapy team specializing in total spine care. These services are coordinated across the continuum of care by a specialized team of physicians including neurosurgeons, orthopedic surgeons, physiatrists and other specialists.

Each patient who is referred to the Outpatient Rehabilitation Center receives a comprehensive evaluation by a licensed physical therapist. A treatment plan is implemented based upon the recommendations from the referring physician and the findings of the evaluation. The therapists are available for on-going communication with the referring physician(s) to discuss the patient's therapy plan and treatment goals and to report on the patient's continuing progress.

Treatment Goals - The program's goal is to help patients reach their optimal levels of function and independence, allowing patients to return to their everyday activities.

At the Institute for Spinal Disorders, our goals are to:

• Decrease Pain
• Improve Activities of Daily Living
• Improve Posture
• Increase Range of Motion
• Improve Tolerance to Work
• Increase Strength and Endurance

Treatment Procedures - The spine experts at the Institute use a wide variety of treatment procedures to help optimize function and reach personal goals for patients on an individualized basis. Treatment procedures may include:

• Gait Training
• Pilates-based Exercise
• Proper Posture/Body Mechanics Instruction
• Range of Motion/Stretching
• Soft Tissue/Joint Mobilization
• Therapeutic Exercise
• Trunk Stabilization

Modalities - A variety of therapeutic techniques are used to reduce muscle spasms, decrease inflammation and eliminate pain. These techniques include:

• Heat/Ice Pack
• Iontophoresis
• Transcutaneous Electrical Nerve Stimulator (TENS)
• Ultrasound

Home Program - Following surgery, patients receive instructions on how to carry on a therapeutic program in their own home. This physical therapy program is designed for patients on an individual basis by our licensed physical therapists.

Bridging the Gap Program - This special program is designed to help ease the transition from a hospital-based physical therapy program to a community fitness program.