Most individuals will experience some kind of low back pain in their lifetime. An episode of back pain may be acute, subacute, or chronic depending on its length. Treatment of low back pain often involves several approaches, one of which is often physical therapy. Many physicians refer patients for physical therapy for a period of four weeks as an initial treatment before recommending a more aggressive option. The goal of treatment is aimed at reducing pain, increasing function, and teaching the patient how to maintain his or her back to prevent future back issues. Determining if physical therapy is effective for back pain depends on the cause of the back pain, the structure of the treatment, and the patient’s adherence to the treatment plan.
The Cause of Back Pain
Back pain – whether upper or lower – is one of the most common issues that makes individuals visit a doctor and is a leading cause of disability around the world. Understanding the causes of low back pain as well as the treatment options, such as is explained in this video, can help one determine if physical therapy may be an effective component of treatment for him or her.
In most cases, back pain may involve symptoms such as:
- Muscle ache
- Stabbing or shooting pain
- Pain radiating down the leg
- Reduced flexibility and range of motion originating in the back
These symptoms and others associated with back pain may be caused by a number of issues. A doctor can rule out any major concerns as well as best identify the cause of back pain using a test or imaging study. Nonetheless, common issues that can cause back pain and discomfort include:
- Muscle or ligament strain, often the result of lifting something heavy or making a sharp, awkward movement
- Bulging or ruptured disks, typically an issue that may be hereditary or the result of overuse of the back
- Arthritis, commonly found as osteoarthritis in the low back
- Skeletal irregularities, generally known as scoliosis or an abnormal curvature of the spine
- Osteoporosis, typically found as compression fractures in bones that have become porous and brittle
Physical therapy is most effective for treating pain that is the result of muscle and/or ligament strains, as it functions to loosen the muscle as well as rebuild strength that may have contributed to the strain in the first place. Nonetheless, physical therapy and exercise can also be helpful for treating issues associated with the other causes of back pain as well. For example, strengthening exercises can reduce the risk of fractures associated with osteoporosis.
Effective Therapy for Back Pain
An effective physical therapy treatment plan for back pain must incorporate active treatment or exercise. Exercise helps strengthen the abdominals and musculature of the low back to provide stability for the lumbar spine. The abdominals provide stabilization by exerting force posteriorly on the spine, while the low back muscles stabilize the spine from the back. Simply put, the bones in the spinal column are surrounded by muscles, and the stronger those muscles are, the less stress is placed on the spine.
Physical Therapy Exercises for Back Pain
Most therapy programs designed to treat upper back pain, as well as issues such as sciatica, incorporate a combination of several types of exercise:
Stretching – Stretching of the muscles helps maintain range of motions and relieves issues of atrophy from lack of use or spasm for poor posture or nerve irritation. To get the most benefit from this type of exercise, a patient should follow a routine that has been specifically designed for him or her by a physical therapist.
Stabilization – Stabilization focuses on strengthening the secondary muscles that support the spine. This type of exercise often includes the use of exercise balls, stabilizing exercises, and/or balancing machines.
Core Work – Core strengthening exercises are designed to create a belt-like support of the muscles in the abdominals and low back muscles around the spine. This component focuses on working the muscles on all sides of the spine to provide maximum stability.
Shortfalls of Physical Therapy
It is not uncommon for a practitioner to refer a patient to physical therapy only to have him or her return saying that he or she stopped going because the therapy hurt or did not offer enough back pain relief. This list is not comprehensive, but it does offer insight into why physical therapy may not provide the anticipated relief:
- The prescribed program does not incorporate the right type of exercise. – Muscle training is as important, if not more so, in providing long-lasting relief from back pain as the use of passive modalities.
- The patient does not do the exercises correctly. – If the patient does not completely understand the prescribed exercises, he or she may perform them incorrectly, resulting in limited relief. It is important for both patient and therapist to communicate effectively and make sure there is full understanding of the treatment prescribed.
- The patient does not follow the prescribed program. – If the patient does not do all of the recommended exercises or does not perform them for the suggested time, he or she will not achieve the desired result.
- The patient does not continue the program long term. – It is in the patient’s best interest to continue with the prescribed therapy exercises and/or exercise program even after being released from the initial course of treatment. If the patient discontinues treatment, he or she may lose the muscle that was developed with the treatment regimen and relapse.
It is common for patients with back pain to successfully complete treatment and then return a year or two later with the same back issue. This recurrence is often the result of the patient successfully strengthening the abdominal muscles and lumbar spine during physical therapy but then discontinuing the exercise regimen and losing the developed muscle strength. To reduce the risk of continued back pain and increase the overall effectiveness of physical therapy, a patient should work with a qualified professional, follow the prescribed regimen during treatment, and then continue the prescribed exercise routine and/or develop a long-term self-directed exercise program.
When it comes down to it, physical therapy can help with low back pain, but it depends in large part on the cause of the pain, the method of treatment, and the individual’s willingness to stick with the treatment plan. To get the most effective treatment plan for you, consult a physician first to rule out any serious concerns and then seek the guidance of a qualified physical therapist to ensure that you follow a thorough plan and avoid any further issues.