New guidelines from the American College of Physicians recommend starting with treatments such as acupuncture, massage, and yoga, and turning to drugs or surgery only when those more active therapies don’t work.

Many of the 3,562 back-pain sufferers we recently surveyed support that strategy. People who sought advice and care from nondrug practitioners were generally more likely to say it helped compared with those who sought care from medical doctors. But insurance often doesn’t cover “alternative” care. Still, it can be worth checking with your insurer and asking for a referral from your doctor, which makes coverage more likely. (See “Does Insurance Cover Acupuncture & Other Nondrug Therapies?” for tips on covering those costs.)

Here, we list the nondrug therapies in the order of how well they performed in our survey, as well as the range that survey respondents said they spent for each treatment, reflecting regional cost variations and differences in the number of treatments received.

1. Yoga and Tai Chi

These exercises strengthen the muscles in your abdomen and back that are crucial to supporting your back. They also improve balance and flexibility, and help you become more aware of a healthy posture. Yoga and tai chi also encourage a quieting of the mind that allows you to focus on movements or postures, which can ease stress and provide mental distance from your pain.

Total Spent out of Pocket: Less than $100 (55 percent) to $1,000 or more (7 percent).

Good to Know: Research suggests that both are best for pain that has lasted three months or longer. Soon after a back injury, it’s okay to try tai chi moves or some yoga if you’re familiar with them, but otherwise, wait. Look for certified tai chi instructors at the American Tai Chi and Qigong Association. For yoga, the Yoga Alliance lists schools and the International Association of Yoga Therapists lists instructors with advanced levels of training. For back pain, consider classes described as gentle or relaxing, and avoid those characterized as more strenuous with words like “power” or “Ashtanga.”

How to relieve back pain. Quote from Linda Huang.

2. Massage

This treatment relaxes tense muscles and increases blood flow to injured areas. It also triggers the release of endorphins, feel-good hormones that decrease stress and anxiety associated with pain.

Total Spent out of Pocket: Less than $100 (35 percent) to $1,000 or more (9 percent).

Good to Know: There’s an art as well as a science to giving an effective massage. Look for a therapist licensed by your state who specializes in sports medicine or who has experience with back pain. A massage shouldn’t make you wince, so make sure that you communicate when the pressure feels good or is too intense.

How to relieve back pain. Quote from Martha Menard, PhD.

3. Spinal Manipulation

This treatment, done by chiropractors and some other healthcare professionals, uses controlled forces—sometimes mild, sometimes firm—to adjust the spine and allow it to move more easily. There are rare reports of serious complications, and though vigorous spinal manipulation shouldn’t be done on people with severe osteoporosis of the spine, it’s usually safe for others.

Total Spent out of Pocket: Less than $100 (38 percent) to $1,000 or more (11 percent).

Good to Know: Licensed chiropractors earn a four-year degree. Physicians with a degree in osteopathic medicine—indicated by a "D.O." rather than an "M.D." after their name—usually focus on primary care and have additional training in the musculoskeletal system. Some doctors of osteopathic medicine offer spinal manipulation as part of their treatment.

How to relieve back pain. Quote from Ronald Farabaugh.

4. Physical Therapy

Physical therapy focuses on improving your ability to do your daily activities and teaches you how to prevent future back problems. Treatments vary, but most combine strengthening and stretching with passive care such as massage and low-level laser therapy (see below).

Total Spent out of Pocket: Less than $100 (56 percent) to $1,000 or more (6 percent).

Good to Know: Physical therapy should be challenging. Once something becomes easy, the therapist should add weight, repetitions, or new exercises. Physical therapists often use hot or cold packs and ultrasound treatments, which warm tissues deep in your body. The treatment can feel good, but you can do it yourself with ice or heat at home. And it’s not clear whether ultrasound yields faster healing. So consider using your valuable appointment time for exercise and other therapies.

How to relieve back pain. Quote from Rachel Feinberg

5. Acupuncture

In Eastern thought, it’s believed that inserting thin needles at specific points on the body helps correct imbalances in qi, the flow of energy. From a Western perspective, acupuncture is believed to affect soft tissue and nerves in ways that lessen pain. For example, it may activate nerves to interrupt pain signals as they travel through the spinal cord to the brain.

Total Spent out of Pocket: Less than $100 (35 percent) to $1,000 or more (8 percent).

Good to Know: Make sure the acupuncturist is licensed in your state. Therapy shouldn’t be painful, but you might feel a slight twitch when a practitioner inserts the needles. Acupuncture is safe as long as you’re in the hands of a trained and licensed practitioner who uses sterile needles.

How to relieve back pain. Quote from Arya Nielsen.


6. Additional Therapies

We don’t have survey results on the following two treatments, but the American College of Physicians says that at least some evidence supports them:

Biofeedback: A therapist will first teach you several relaxation techniques, such as deep breathing and progressively tensing and relaxing muscles throughout your body. Then you’ll be connected via electrodes to computer monitors that track your heart and breathing rates, muscle tension, and skin temperature. The idea is that by watching the monitors while practicing these techniques, you can learn to relax tight muscles in your back and decrease physical reactions to daily stress that can worsen pain.

Low-Level Laser Therapy: Pointing a laser at the injured site causes blood vessels to dilate, which can increase blood flow to the area. The laser may also temporarily desensitize pain receptors. Ask which type of laser will be used in your treatment. Class IIIb lasers, which are typically used to treat pain, are safer because they don’t heat the skin or underlying tissue.

Editor's Note: This article also appeared in the June 2017 issue of Consumer Reports magazine.

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).