Spine Care Without Surgery

Make an Appointment
For the Charlottesville area:
For Culpeper:

At UVA, we can treat most back and neck issues without surgery. We seek the least invasive treatment option possible and only consider surgery after we've exhausted nonoperative options.

Nonoperative treatments may include:

  • Physical therapy
  • Spinal braces
  • Cervical braces
  • Lumbar braces
  • Drugs to manage pain and symptoms
  • Spinal injections

Physical Therapy

Physical therapy can help you improve and maintain the functional abilities you need for daily activities. 

Physical therapy options include:

  • Passive therapies, which include spinal manipulation, myofascial release and ultrasound
  • Active therapies, which include exercises intended to increase flexibility, build strength and endurance. These could include lower back exercises, back stretches and back strengthening exercises.
  • Biomechanics, including posture correction and learning how to move properly and 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.
  • Electrical stimulation (Transcutaneous Electrical Nerve Stimulation) — TENS delivers a painless electrical current through the skin to specific nerves. This can relieve stiffness and pain and may improve a range of motion.
  • Myofascial release —  Fasciae are layers of connective tissue that support muscles, bones and organs. Stress and poor posture may cause the fascia to constrict or tighten, which can lead to pain. Using their hands and arms, physical therapists firmly and gently 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, back and neck pain and other spinal disorders may benefit from aquatic therapy. Treatment often occurs in a heated tub or pool and can help:
    • Flexibility
    • Mobility
    • Coordination
    • Weakness
    • Weight-bearing intolerance
    • Pain
  • Therapeutic exercise — Everyone can benefit from therapeutic exercise. Benefits can include:
    • Improved flexibility
    • Stronger muscles
    • Relieved stiffness
    • Better balance, coordination and sleep
    • Improved heart health
    • Pain relief

Back and Neck Braces

Braces can be treatment options for a range of neck and back injuries. Although they can be uncomfortable, braces can play a major role in immobilizing and supporting the spine or neck and can even help correct spinal deformity.

Some common braces include:

  • Cervical collars, which may be hard or soft and are used to keep the neck immobilized after injury or surgery.
  • Hard or soft neck braces, both of which assist in healing by restricting neck movements. Hard braces are usually used to help recover from more severe injuries.
  • Soft lumbar corset, which aids in low back muscular support. Corsets, which are used to provide lower back pain relief or to restrict certain motions, are usually worn for a specific period of time.
  • Rigid lumbar braces, which provide additional spinal stability for use instead of, or in addition to, surgical correction. These braces provide additional immobilization that allows the back to heal with minimal risk of further 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 feel better by allowing you to sleep
  • Transdermal analgesics, which deliver pain relief through a skin patch 

Spinal Injections

Your doctor can inject medications into an area of the spine and may:

  • Diagnose or confirm the cause of the pain
  • Relieve inflammation and pain
  • Temporarily or intermittently relieve pain
  • Provide no pain relief

Your reaction to the injection can help your doctor better diagnose the root cause of your back pain.

Temporary relief can also help make other treatments such as physical therapy and chiropractic adjustments more beneficial.

Patients whose pain is adequately relieved or reduced by a spinal injection may undergo additional injections at specific time periods.