1. Therapeutic MassageMassage relaxes muscles and other soft tissues and increases blood flow and oxygen in affected areas, thus encouraging healing and recovery.
HAS IT WORKED? Cherkin led a randomized trial, published in the Archives of Internal Medicine in 2001, that found therapeutic massage effectively treated lower-back pain over the course of a year. Group Health subsequently included massage under its covered benefits for chronic back pain.
FIND THE RIGHT SHOP: In addition to becoming certified, therapists can enroll in courses that teach hundreds of specialized techniques. For the lower back, seek out those who have trained in neuromuscular and myofascial modalities. Consult the National Certification Board for Therapeutic Massage and Bodywork's online directory at ncbtmb.com.
This traditional Chinese treatment has become mainstream in the U.S., with more than two million patients annually. Thin metallic needles are inserted just below the skin to release blockages in energy flow (called qi) and return the body to a balanced state. Acupuncturists may twirl the needles or apply heat or a slight electric current during the treatment.
HAS IT WORKED? Studies called for by the National Institutes of Health have shown acupuncture to be effective in curbing postoperative pain and nausea, as well as fighting the effects of arthritic knees. In the same study in which Cherkin found massage to help curb lower-back pain, he found acupuncture to be only slightly less effective.
FIND THE RIGHT SHOP: Forty-two states regulate acupuncture through the National Certification Commission for Acupuncture and Oriental Medicine; search for a certified practitioner at nccaom.org.
3. Chiropractic Manipulation
Fans and skeptics alternately laud and lampoon this treatment. The most common practice is an "adjustment," wherein the practitioner gives a quick, controlled force to a particular joint in your spine. The manipulation is sometimes punctuated by an audible "pop," which is the sound of the joint repositioning. This adjustment is believed to fix the spinal misalignment causing pain.
HAS IT WORKED? Even with numerous studies, the jury is still out. A randomized trial in 2002 found it to be as effective as conventional medicine. In Cherkin's own research, published in The New England Journal of Medicine in 1998, he found it to be "only marginally better than the minimal intervention of an educational booklet."
FIND THE RIGHT SHOP: Chiropractors complete a four-year classroom-and-clinical program and take state or national exams. Look for licenses and a degree from an accredited chiropractic college.
Anyone who can do a cobra pose can't have back pain. Yoga incorporates controlled breathing while putting your body through a series of stretches and poses, in order to promote strength and flexibility.
HAS IT WORKED? Cherkin's colleague Karen Sherman led a study (published in the Annals of Internal Medicine in 2005) that found yoga to be effective in not only improving back-related function but reducing chronic pain over the course of a 26-week period.
FIND THE RIGHT SHOP: Without one certifying body, you're limited to asking instructors how long they've been teaching and what they've done to update their methods. Talk to current students to see if a teacher is right for you.
5. Alexander Technique
Developed by an Aussie Shakespearean actor (really), it's a hands-on technique for improving posture, coordination, and movement. During one-on-one lessons, a teacher guides you in various positions and movements, focusing primarily on the relationship between the head, neck, and torso. It takes about 30 classes to pick up.
HAS IT WORKED? Long embraced in performance circlesit's a required course in Juilliard's dance and drama programsAlexander Technique was accepted as a component in most of Switzerland's national-health-care packages to combat chronic pain. Cherkin has not studied it.
FIND THE RIGHT SHOP: More than 700 teachers are registered with the American Society for the Alexander Technique (alexandertech.org); all have completed at least 1,600 hours of training over a minimum of three years. Beware of "bodyworkers" who have not completed such detailed training.