· NSAIDS (Non- steroidal anti-inflammatory drugs). It is generally accepted to be first step in the management of spondylosis.
· Opioid medications are an alternative therapy for patients suffering from gastrointestinal side effects due to poor control of NSAID management.
· Antidepressants- used for treatment of lower back pain because of their analgesic value at low doses.
· Muscle relaxants- may provide benefit with regard to short-term pain relief and overall functioning.
· Epidural steroid injections, lumbar facet joint injections, SI joint injections.
2. Surgical Management:
· Lumbar fusion- used generally when conservative management has failed and patient still suffers from pain after 6 months. Two vertebrae are fused together and will subsequently work like one solid vertebrae. After two years the bony fusion can be considered high.
· Artificial Disc Replacement (ADR)- Artificial Disc replacement is the replacement of degenerated intervertebral disc with an artificial disc in people with degenerative disc disease of lumbar and cervical spine that has been unresponsive to non- surgical treatments for at least 6 months.
3.Physical therapy management- can be divided into various exercise-based and behavioral Interventions:
· Exercise therapy- therapy includes aerobics exercise, muscle strengthening, and stretching exercises. The exercises and programs have to be of various intensity, duration and frequency.
· Traction- helps to relieve chronic low back pain. The traction forces open intervertebral space and decreases spine lordosis.
· Manual therapy- it is conservation treatment, involves spine manipulation. There might be a risk using spine manipulation, there is a risk of calcifications in the spine.
· Massage- Even though massage therapy needs research for the effectiveness, it appears to have a potential role in beneficial pain relief.
· TENS (transcutaneous electrical stimulation)- frequently used, appears to give an immediate reduction in pain following the therapy. Nevertheless, there remains little evidence for long term relief.
· Taping- It helps to relieve pain in lower back. This tape could be standard tape or kinesiotape. It is important to note that taping alone is not enough, it should be used during therapy to improve the range of motion (ROM).
· McKenzie exercises- focuses on extension and has promising results concerning the prevention of further degeneration of lumbar spine.
· Lumbar back support- can be beneficial for patients suffering from lower back pain. It occurs to limit spine motion, stabilize, correct spine deformity and reduce mechanical forces.
· Lumbar support- with the help of braces are used for stabilization and reducing mechanical forces. They are also produced to limit spine motion and correct deformity of spine.
Patient Education- educating patient must include reviews of lumbar anatomy, explanation of the concept of posture, ergonomics and giving appropriate back exercises.