According to one of the leading thinkers in the field of complementary medicine, Edzard Ernst, "Acupuncture, spinal manipulation and water injections are worth trying … in conjunction with analgesics and regular physical exercise. The most important advice to back pain sufferers is to keep up normal activity as much as possible and to realize that having back problems is not a disease but entirely normal" . Clearly, alternative therapies for back pain have not only wide usage  but are supported by a variety of clinical studies, some better than others (Table 3). Overall evidence for effectiveness of many alternative therapies remains inconclusive, with small to moderate effect in some populations. This is similar to findings for conventional therapies for LBP. The condition is just as difficult to study for either conventional or alternative therapies . The variety and range of potentially beneficial interventions for LBP suggests that one of the most powerful elements in improving outcome is that the patient believe the specific therapy will improve their function and pain - and, along with it, for the physician to use that belief in initiating, at an early stage, a targeted activity program. With little ability to make a definitive diagnosis and determine precisely what is needed, perhaps the best advice is to remain flexible in terms of recommending various therapies. The clinician must pay attention to both their own and their patients' preferences while considering the availability of qualified complementary or alternative therapists in their community.
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