You’ve been hurting for months. You can’t stay on your feet for more than a few minutes. It hurts to sit for too long. Recently you can’t get a good night’s sleep because you just can’t get comfortable. The painkillers aren’t working, and you’re starting to think seriously about back surgery. But after all the expense, rehabilitation and risk, will you bet better off? There are alternatives to surgery, and they just might work for you.

Back pain that leads to surgery is often associated with a damaged intervertebral disc or spinal stenosis. The discs are the tough, flat cushions between the vertebrae. Imagine a disc as the warm toasted marshmallow sandwiched between two graham crackers in a s’more. If the crackers are pressed together evenly, the marshmallow will spread out evenly as well. If you squeeze just one side of the sandwich together, the marshmallow (or disc) will ooze out to the opposite side. That’s what happens with a “slipped” disc. The protruding part can irritate a nearby nerve. If it ruptures, there can be chemical irritation of the nerve as well. The discs also tend to degenerate, flatten and become less resilient over the years, so there is less space for the nerves where they come out of the spinal column.

Sciatica is an irritation of the sciatic nerve. It can cause radiating pain, burning sensations or cramping in the buttocks and down the leg. This may be caused by a nerve root problem in the lower part of the spine, but it can also be caused by impingement further down in the area of the buttocks. The piriformis muscle runs across the back of each hip joint, deep in the buttock, where it crosses paths with the sciatic nerve. Pressure from an overly tight piriformis muscle is believed to irritate the sciatic nerve causing buttock and/or radiating leg pain. This is known as piriformis syndrome. It can be addressed by releasing excess tension and any “trigger points” (knotted areas) in the piriformis and associated muscle groups.

Stenosis is a narrowing of the spinal canal that leads to compression of the enclosed spinal cord and nerves. Fractures of the spine can also result in unstable vertebral joints and irritation to the spinal nerves.