Concurrent with, and following treatment with the major treatment modalities which can lead to rapid symptom relief, these ancillary treatment modalities can be extremely beneficial with respect to rehabilitation of muscle strength which was lost during the period of active pathology. The following are the authors' views regarding some of the major ancillary treatment modalities. All patients are encouraged to incorporate some of these modalities into their treatment and rehabilitation regimen.

Unfortunately acupuncture, while effective for certain clinical conditions, has not been successful for our patients with serious forms of back pain caused by disc herniation. Acupuncture is therefore not a recommended treatment modality for our patients with severe pain caused by disc disease.

Chiropractic, on the other hand, has provided a good deal of symptomatic relief for a number of our patients. A number of chiropracters understand the limitations of other treatment modalities, including surgery, and now have knowledge, through the experience of their own patients, of the potential beneficial effects of Targeted Anti-Cytokine Therapy®(TACT®). TACT patients may continue their chiropractic treatments before, during, and after TACT.

Yoga is a wonderful physical discipline and may be beneficial to increase strength, balance, and range of motion. Yoga can exacerbate certain back conditions, however, and therefore physician clearance is recommended for patients with back pain prior to beginning yoga. Patients with acute pain will usually be unable to tolerate the normal yoga regimen. Yogic breathing and upper body exercises, however, can be extremely beneficial. After successful treatment gradual resumption of lower body postures can be very effective for developing lower body and abdominal strength and stability. As with any discipline it is always best to find the best teachers you can, and to study diligently.

The experiences of our patients who have had facet injections has generally not been favorable. This technique is no longer widely advocated.

There is some published data suggesting efficacy, at least for a certain subset of patients. Because we have a concern with the long-term results from a therapeutic modality which is destructive, and which could theoretically produce further damage to the disc capsule, we cannot enthusiastically recommend this modality at this time for the majority of patients.

Aquatherapy, encompassing a variety of in-water exercises, is highly recommended. It is excellent to maintain muscle tone and strength, and is particularly suited to rehabilitation regimens. Some aquatherapy centers specialize in rehabilitation for back patients. The authors feel this should be a standard part of the regimen for all patients with back disorders, both for rehabilitation and for maintenance.

Also highly recommended, especially if one can find a therapist skilled with back rehabilitation, and who realize the limitations, as well as the physical requirements of patients with back disorders. Again the key is finding a skilled practitioner, one who makes your body feel better (your body can usually tell!).

Cortisone can be given in various formulations. It is the active ingredient in epidural steroid injections, and this modality has a place in the treatment of patients with inflammatory radiculopathy. Oral forms are also available, and are generally well-tolerated if limited to a short course of one or two weeks. Longer treatment regimens are not recommended.