Low Back Pain  Acupuncture  Herbal Medicine  Magnetic Therapy  Manual Therapies  Movement Therapies  Nutritional Approaches Complementary Approaches Movement Therapies In an integrative approach to the treatment of chronic low back pain, movement therapies can potentially be helpful in a variety of ways: releasing muscle spasms, improving flexibility, enhancing posture and alignment, learning new ways of moving that emphasize freedom and ease, increasing body/mind awareness and positive body image, relaxing the mind and body, and supporting a meditative and calm mental attitude. Although many of these approaches have not been studied extensively in clinical trials, anecdotal evidence and case reports are suggestive of their benefit for musculoskeletal conditions and their accompanying emotional and psychological distress. Eastern Movement Practices Tai Chi and Qigong: Tai Chi and Qi Gong are generally very safe movement practices---in fact their main adherents are the elderly in Asia. Several recent studies have evaluated the use of these approaches for chronic back pain. In a 1997 study, the use of a combination of strategies for chronic low back pain (an educational component, relaxation training and Qigong movement therapy) was shown to improve pain perception ratings, mood state and functional status. This mind-body model supported the usefulness of a combination of interventions to address cognitive attitudes toward pain, to achieve relaxation and to aid in restoring physical function (Berman and Singh, 1997). In another study participants practicing six weeks of daily t'ai chi chih (a form of qigong) showed significant reductions in pain intensity and statistically significant improvement in mood as compared with the control group who received routine care only. Qigong was seen as a valuable additional tool in the treatment of chronic low back pain (Bhatti, 1998). Yoga: Yoga has a potential role in the treatment of chronic low back pain based on its ability to influence both physical and psychological factors. An important part of pain management involves the emotional component of pain, such as coping with pain distress, regaining a sense of control, decreasing the fear of pain, decreasing anxiety and depression, and increasing pain tolerance. Many aspects of yoga, which commonly comprises postures or asanas, breathing, and meditation, address these issues. The regular practice of yoga may increase self-awareness and relaxation, improve respiration, increase self-acceptance and self-understanding, enhance a sense of control, lead to healthy life style improvements, and often change the context of pain. On a physical level, regular practice can enhance strength, balance and flexibility. Therapeutic yoga is geared to those with back and other problems and uses props to enable patients to perform the postures so as to increase spinal flexibility and range of motion. Restorative yoga techniques have been developed to help individuals with physical conditions such as chronic back pain perform yoga in a safe and beneficial manner to achieve a deep state of relaxation. Most of the research on yoga has been conducted in India and is relatively inaccessible. Interest and research in the West has been growing, however. Regarding back pain, yoga has been found to promote stress reduction and positive mood (Kerr, 2000, Schell, 1994). It has been incorporated into various programs for musculoskeletal pain. Hatha yoga, along with breathing and meditation, is part of the program at the Stress Reduction Clinic at the University of Massachusetts Medical Center founded by Dr. Jon Kabat-Zinn. In a four-year follow up of his chronic pain program Dr. Kabat-Zinn found that more than 90 percent of the people who completed the program kept up with the program after four years and most rate their training as very important to their improved health status (Kabat-Zinn, 1986). More clinical trials may be helpful in determining the specific benefits of yoga for chronic low back pain. Yoga must be done carefully and with supervision for people with low back pain. Performing certain postures---particularly ones that twist or bend the spine-- could actually be harmful to people with low back pain. Western Movement Systems These therapeutic approaches are based on the concept of movement re-education. Addressing issues such as patterns of chronic tension and holding, posture and alignment, and ease of movement, they focus on how these contribute to pain, restriction and physical discomfort. They are considered lessons rather than treatments and consist of individual sessions, group movement classes and home practice. While little research has been done on these movement re-education approaches for chronic low back pain per se, they are of interest as additional treatment options because of their gentleness and their ability to affect the psychological as well as physical components of pain. There is much anecdotal evidence on the usefulness of these approaches for pain conditions and they are being increasingly incorporated into standard rehabilitation medicine departments as part of a comprehensive physical therapy program. They offer the patient another opportunity to participate in the healing process and to initiate and sustain through practice positive changes in movement, posture, self-awareness, flexibility, self-image, relaxation and self-esteem. Like exercise and other movement approaches, however, they do require time, attention and practice in order to change habitual movement patterns that may contribute to a chronic pain syndrome. Alexander Technique: The Alexander Technique, through its focus on correct use of the body and increased mental and physical awareness, addresses dysfunctional movement patterns and overall stress patterns that may contribute to chronic low back pain. Most of the information on its benefits derives from anecdotal reports and case studies. Several scientific studies, however, have shown it to be of some benefit for stress reduction, back pain during pregnancy and chronic pain (Atchison, 1999). Feldenkrais Method: The Feldenkrais Method is based on the concept that there are multiple choices in the way one moves and that through guided movement sequences an individual can learn pain free ways to move with ease. This process of re-education is not only considered therapeutic but preventive, as one learns a way of functioning that do not reinforce muscular and postural patterns that can lead to or maintain chronic back pain. Reports of the benefits of this method for chronic low back pain, per se, are primarily anecdotal and suggest the need for scientific research on this well regarded movement re-education system. The Trager Approach: The Trager Approach specifically addresses the release of patterns of muscular tension, holding, and restriction as well as underlying mental/emotional patterns of stress and tension, it is particularly applicable to the management of chronic low back pain. Currently the application of this approach to the specific chronic low back pain condition has not been studied scientifically, although there is ample anecdotal evidence of its effectiveness for back pain and other chronic musculoskeletal pain conditions.