Spine Care Without Surgery

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Many people with spine conditions find relief without surgery. At UVA Health, we offer the full range of nonsurgical treatments, including some you can't find everywhere. Our compassionate experts, including pain management specialists, physical medicine and rehabilitation doctors, and physical therapists, will build an individualized treatment plan, keeping your goals for treatment in mind.   

Injections & Procedures

We offer injections, procedures, and more to target and reduce your pain.  

Medial Branch Block & Radiofrequency Ablation  

This treatment for back and neck pain starting in one of your facet joints can relieve pain for 6-12 months. Your facet joints — found between your spine bones — help you move your neck and back. This treatment has 2 steps.  

Step 1: Medial branch block — We use medial branch nerve block injections to find out if your facet joints are causing your pain.   

Using imaging to help us see, we guide small needles close to the medial nerves in your facet joint. Then we inject the nerve block.  

If the nerve block helps your pain, then we know your pain comes from your facet joints.  

Step 2: Radiofrequency ablation — We’ll guide a thin, hollow needle to your medial branch nerves. We use a radiofrequency current to burn and destroy the nerve.  

Sacroiliac (SI) Joint Steroid Injection  

This injection for lower back pain coming from your sacroiliac (SI) joint can last days to months.

Using imaging to help us see, we’ll guide a needle to your SI joint. Then we’ll inject a steroid into the joint.  

The steroid reduces inflammation, which eases your pain and stiffness.   

Basivertebral Nerve Ablation  

UVA Health was among the first centers in Virginia to offer this treatment that can relieve lower back pain for up to 5 years or more.

Using a special X-ray to help us see, we guide a heat probe to your basivertebral nerve. We target the nerves with heat to destroy the nerve ending. This keeps the nerve from sending pain signals to your brain.   

Epidural Steroid Injections  

These can ease lower back pain that moves down 1 or both hips and/or legs  for week to months.

 Using imaging to help us see, we’ll guide a needle to the right position in your back. Then we’ll inject a steroid medicine. The medicine reduces inflammation, which eases pain.   

Spinal Cord Stimulators

A spinal cord stimulator is an implanted device that sends low levels of electricity to the spinal cord. It helps relieve pain, especially pain that moves down 1 or both arms or legs. Learn more about spinal cord stimulators

Restorative Neurostimulation

An implanted restorative neurostimulation device treats low back pain from an impaired multifidus muscle (multifidus dysfunction). See how it helped Monique find lasting relief.
Watch Monique's Story


Acupuncture involves inserting thin needles in certain points of the body. In some cases, it can help relieve back and neck pain.

Trigger Point Injections

Myofascial trigger points are "knots" in a tight band of muscle that cause pain. Trigger point injections involves putting a thin needle into the trigger point and injecting an anesthetic. The needle helps break up the trigger point and the anesthetic helps relieve pain. 

Physical Therapy

Physical therapy works to improve your strength, endurance, and flexibility. That reduces your pain and helps you move better.   

Physical therapy may include:

  • Passive therapies: spinal manipulation, myofascial release, and ultrasound
  • Active therapies: exercises and stretches
  • Biomechanics: posture correction and learning to move safely 

Passive Therapy

Passive therapies we offer include:

  • Manual therapy (manipulation and mobilization) — These therapies involve restoring and increasing mobility. Your therapy may also help reduce muscle spasms that contribute to spinal nerve irritation.
  • Transcutaneous electrical nerve stimulation — TENS delivers a painless electrical current through the skin to specific nerves. This can relieve stiffness and pain and improve range of motion.
  • Myofascial release —  Fascia are layers of connective tissue that support muscles, bones, and organs. Stress and poor posture may cause the fascia to constrict or tighten, causing pain. Using their hands and arms, physical therapists stretch the fascia.
  • Ultrasound — This common noninvasive therapy treats back and neck pain, tendon and ligament injury, muscle spasms, joint problems, and other spine-related conditions. Ultrasound promotes circulation and healing, relaxes muscle spasms, decreases inflammation, and helps alleviate pain.
  • Ice and heat therapies — Cold treatments can help reduce blood flow and decrease swelling, inflammation, and pain. Heat therapy can help relax stiff and sore muscles.

Active Therapy

  • Aquatic therapy (hydrotherapy) — Patients with arthritis, spinal stenosis, other spinal disorders may benefit from aquatic therapy, which can help:
    • Flexibility
    • Mobility
    • Coordination
    • Weakness
    • Weight-bearing intolerance
    • Pain
  • Therapeutic exercise — This helps by:
    • Improving flexibility
    • Strengthening muscles
    • Relieving stiffness
    • Improving balance, coordination, and sleep
    • Relieving pain

Back & Neck Braces

Braces can help a range of neck and back issues. Common braces include:

  • Cervical collars keep the neck immobilized after injury or surgery
  • Neck braces help you recover from more severe injuries
  • Soft lumbar corsets support the muscles in your lower back
  • Rigid lumbar braces help your back heal after injury


Even a simple back sprain can cause life-altering pain, but certain medications can help ease your discomfort. Our doctors and nurses may prescribe medications alone or as part of a treatment program that may include surgery or nonoperative care like physical therapy.

Medications we use for back pain include:

  • Narcotics (opioids), which can be used for a short time to control serious pain
  • Muscle relaxants, which help relieve muscle tightness, spasms, and cramping
  • Non-steroidal anti-inflammatory drugs (NSAIDs), which help reduce inflammation and pain
  • Sedatives, which can help you sleep
  • Transdermal analgesics, which deliver pain relief through a skin patch