There are many options available for adjunctive treatment of pain, including physical therapy modalities, transcutaneous nerve stimulation, and acupuncture. But the primary treatment remains correction of the mechanical problem by unloading the disk. This means that patients should progress from lying to standing before sitting is associated with higher disk pressures and increased risk for further herniation of disk material.

When sitting, patients should obtain and use lumbar support cushions to reduce the "flexion" or slump in the small of the back. In fact, newer makes of cars (especially some European models) are built with a knob that "dials in" lumbar support to accommodate the driver’s natural curve and thus again unload the disk. Corsets work in a similar way by encouraging proper posture and possibly reducing disk pressure.

Patients who strain at stool, cough or sneeze do to take stool softeners, cough medications and decongestants in an effort to minimize disk pressure.

The greatest breakthrough in treatment of back pain is the advent of Back Schools. An idea that originated in Europe, these concise multi-session classes are generally taught in small groups and provide the low back sufferer with knowledge, mechanical and postural advice, and exercises, as well as a "game plan" with which the patient can assess on his own when he needs more professional help and when he can "go it alone". In one large study, graduates of a Back School had fewer back injuries, and even those with a recurrent back pain episode were able to return to work sooner than patients who had not attended.

Manipulation has not been proven effective in diskogenic low back pain, and only traction with heavy weights shows some promise. Two recent options, autotraction and gravity-eliminated traction, use the patient’s upper body strength or body weight to separate the vertebrae in the back and hopefully relieve pressure on the disk. These are fairly new techniques that seem promising.

Exercise, including pelvic tilts, sit-ups and knee-to-chest stretches, although good for low back conditions involving arthritis or muscular strain, may actually worsen the disk condition. These exercises have been proven to increase the pressure on the disk and may cause more herniation if done in the acute stage. A mild program, gradually progressive, of gentle extension (regaining the natural arch of the back) shows greater promise, provided this can be done passively, without excess effort of back muscles. Only as the patient recovers is strengthening of back and abdominal muscles recommended. The exact timing and program of advancing one’s lifestyle and exercises is best planned with the help of a physical therapist, and under medical supervision.

Only when the above measures fail, should epidural steroids (injections outside the spinal canal) or surgery be seriously considered as options. Although most patients can avoid surgery and gradually return to lead normal lives, some victims simply cannot obtain relief until they undergo surgery. Although no guarantee of success, improved diagnostic procedures and surgical techniques in conjunction with a good post-operative program does offer hope to the majority of people properly selected for surgery.

As professionals and patients alike learn more about the mechanics of how the body works, lower back pain prevention and treatment should continue to become more scientific and more effective, and the burden upon society will be lightened. In the meanwhile, focusing on what we do know and dispelling old myths will have to suffice.