Multiple modalities are commonly employed to reduce low back pain. They are especially useful in alleviating acute low back pain (e.g. an intense, debilitating episode of low back pain) for the patient. Physical therapists or chiropractors usually use passive modalities.

Heat/ice packs for heat therapy
and cold therapy
Heat and/or ice are easily available and are the most commonly used type of modality. Each type of therapy helps reduce muscle spasm and inflammation.

Some patients find more pain relief with heat therapy using heat packs and others with cold therapy such as ice massage. The two may also be alternated. They are generally applied for 10-20 minutes once every two hours, and are more useful early on (the first few days) in the course of an episode of pain.


Iontophoresis
Iontophoresis is a means of delivering steroids through the skin. The steroid is applied to the skin and then an electrical current is applied that causes it to migrate under the skin. The steroids then produce an anti-inflammatory effect in the general area that is causing pain. This modality is especially effective in relieving acute episodes of pain.


TENS units for electrotherapy
A transcutaneous electrical nerve stimulator (TENS) unit uses electrical stimulation to modulate the sensation of low back pain by overriding the painful signals that are sent to the brain. A trial of electrotherapy with the TENS unit is usually done first, and if the patient experiences substantial pain relief, a TENS unit may be used at home for low back pain relief on a long-term basis.


Ultrasound
Ultrasound is a form of deep heating in which sound waves are applied to the skin and penetrate into the soft tissues. Ultrasound is especially useful in relieving acute episodes of pain and may enhance tissue healing.