This year, millions of procedures and prescriptions will be ordered in an effort to assuage low back pain, and sadly, few will help.

“The history of low-back pain management is that we’ve seen treatment after treatment that’s been hyped as the next miracle cure. There isn’t one,” says Roger Chou, MD, a primary care physician at Oregon Health and Science University in Portland who specializes in managing low back pain.

But when people go to their doctors in agony, frustrated and unable to move, not doing anything doesn’t usually seem like good option to either party. So it has become common for doctors to send low back pain patients for an MRI scan to find the cause.

The problem is that many people have some wear and tear in their spines that doesn’t usually cause discomfort. In one study, one in three adults over age 60 had herniated or slipped disks detected by an MRI but no back pain.

“If you did this scan on somebody who just complained of back pain after gardening over the weekend, you’d be sorely tempted to assume that something [you see in the scan] has to explain this person’s pain,” says Richard Deyo, MD, a family medicine physician and deputy editor of the journal Spine.

That may explain why people who get MRIs for low back pain have twice as much surgery but exactly the same outcome as those who don’t get scanned. 

Before you pay top dollar for therapies with questionable benefits, see what science has to say when it comes to some of the most common treatments:

1. Watchful waiting: Doctors keep tabs on symptoms but hold off treatment.

Evidence: Studies show that 80 percent of episodes of low back pain will resolve without treatment in four to six weeks.

Risks: While most low back pain is a muscular problem, very rarely, low back pain results from cancer, fractures, infections or inflammatory forms of arthritis, and waiting may allow a serious issue to go unchecked.

Ideal use: Wait out new pain if you don’t have a history of corticosteroid use or if your pain didn’t start after a sudden trauma, like a fall.

 

2. Physical activity: Aerobic exercise, resistance training and stretching

Evidence: One large review found that a supervised, individualized exercise program of stretching and strengthening improved low back pain by 19 points on a 100-point scale.

Risks: Participating in sports that involve sudden twisting or jerking motions, such as racquetball, may make back pain worse. Resistance training with free weights is not advised.

Ideal use: Work up to 2½ hours of walking, strength training on machines or aerobic exercise on machines a week.

 

3. Bed rest: Lying down to let back muscles rest until the pain subsides

Evidence: Studies comparing bed rest to activity for low back pain find that people who stay active have less pain.

Risks: Bed rest that lasts more than a few days can make back pain worse.

Ideal use: If you can’t move without pain, a day or two in bed may help, but more than three and you risk losing muscle tone, which can make back pain worse.