Rid that pesky low back pain for good with a lower back pain physical therapy treatment that targets the source of the pain — not just the symptoms
Are you considering physical therapy to feel relief from your lower back pain?
Physical therapy is often the best method of treatment for low back pain because it can pinpoint the cause of the pain to diminish the pain for good.
Those who seek physical therapy as a treatment for low back pain are less likely to have reoccurring back pain or develop chronic pain than those who try other forms of treatment, according to a report from UC Berkeley School of Public Health (2019).
Are you ready to wave goodbye to your lower back pain? This guide covers everything you need to know about lower back pain physical therapy, including which conditions a physical therapist can treat and how a physical therapist will treat them.
What is Physical Therapy and How Can it Help?
First, we will answer the common question: what is physical therapy for lower back pain?
Physical therapy is widely regarded by medical professionals as one of the best ways to treat back injuries and pain. This type of treatment relieves pain and helps people of all ages and fitness levels recover from injuries in the least invasive way possible.
Unlike temporary solutions that treat the symptoms of back pain, physical therapy treats the cause. When the cause is treated, the symptoms are less likely to reoccur, saving patients from prolonged frustration and further medical expenses.
A large study of 753,450 patients from 18-60 years of age revealed that medical costs were more than $1,202 lower in patients who entered a physical therapy program shortly after experiencing back pain or injury compared to patients who delayed physical therapy treatment (Childs et al., 2015).
For those who have chronic low back pain (pain that has persisted for more than 12 weeks), physical therapy is still considered the best form of treatment.
According to a recent scientific report, physical therapy is considered a “first-line” treatment for chronic back pain since it is regarded as a highly effective and safe way to alleviate chronic pain (Shipton, 2018).
Physical therapy patients are given a treatment plan that includes stretching, strengthening, and other recommendations to feel relief from pain or injury.
A physical therapy treatment plan is targeted to each patient’s specific needs and symptoms and is prescribed by a physical therapist.
When Your Back is Aching, a Doctor of Physical Therapy is the Expert You May Need
Physical therapists who treat back pain are professionally trained Doctors of Physical Therapy (DPT) and are educated in the evaluation and conservative management of spine disorders.
Unlike other doctors you may have seen for your lower back pain, physical therapists avoid prescribing painkillers or invasive procedures to minimize the pain.
Instead, a physical therapist will distinguish the cause of the pain and take a whole-body approach to treat that cause, so that the pain won’t keep coming back.
Typically, low back pain stems from weakness and a lack of flexibility in certain areas of the body. Your physical therapist will likely give you a combination of stretching exercises, strengthening exercises, massage/foam rolling therapy, and heat/cold therapy to increase your strength and flexibility.
The specific types of exercises and physical therapy treatments that you receive will depend on the condition and your history of pain and other treatments.
Initially, many patients see their physical therapist about one or two times a week. The physical therapist will continue to monitor the patient’s progress and adjust their plan of care and treatments as see fit.
Typically, the best lower back pain physical therapists will also perform manual therapy and/or spinal manipulation on patients. A physical therapist will use his/her hands to press down on certain points, mobilize joints, and increase circulation in the injured area during manual therapy and spinal manipulation.
These types of treatments ease a patient’s pain and increase a patient’s mobility in the injured area for long-term relief.
Manual therapy and spinal manipulation provided by a physical therapist are considered safer alternatives than visiting a chiropractor. Chiropractors tend to use more aggressive approaches to back pain relief that carry a greater risk of injury and negative consequences.
How to Prepare for Your Lower Back Pain Physical Therapy Appointment
Before you go to your first physical therapy appointment for your lower back pain, observe your pain so that you can help guide your physical therapist to an accurate diagnosis and treatment plan. Make note of the following information:
What Makes Your Pain Better or Worse?
Pay attention to what makes your back feel better or worse. For example, do you feel that the pain is alleviated when sitting, standing, or sleeping? Factors such as posture affect your lower back pain. Consider the following information to share with your doctor during your first visit:
- Age: Back pain is more common in adults as they age, usually starting around the age of 30 or 40
- Exercise: Are you not exercising enough? Inadequate fitness can lead to weak, unused muscles. The CDC recommends that adults perform 75 minutes of vigorous aerobic exercise or 150 minutes of moderate-intensity aerobic exercise each week along with two days a week focused on muscular strengthening exercises.
- Your Weight: Excess weight can strain your back
- Disease: Certain diseases, such as cancer or arthritis, can cause back pain
- Psychological Conditions: Psychological conditions, such as anxiety or depression, can lead to back pain
- Improper Lifting Technique: When lifting weights or other objects, you should feel that you are lifting them from your legs, and not your back. Improper lifting techniques can lead to pain and back injuries. Maintain good posture and squat down to pick up the weight or object, bending only at the knees and hips. Stand back up in good posture, straightening only the knees and hips.
- Smoking or Using Nicotine Products: Research has shown that the use of nicotine products, especially via smoking, vaping, or e-cigarettes, can reduce blood flow to the spine, which prevents the delivery of nutrients to the discs in your back. Studies have revealed that smoking also slows the healing process.
A team of spine surgeons has noted that nicotine can also intensify Degenerative Disc Disease (when wear-and-tear of spinal discs cause pain) and increase the risk of osteoporosis (a condition that decreases bone density and can contribute to fractures), (Spinasanta et al., 2019).
How long have you suffered the pain?
Let your physical therapist know how long you’ve had the pain. Your physical therapist will need to know this information since acute, sub-acute, and chronic pain will each require a different treatment plan.
- Acute Pain = pain that started within the past week
- Sub-acute pain = pain that you’ve had anywhere from a week to twelve weeks
- Chronic pain = pain that you’ve had for more than twelve weeks
What Treatments Have You Tried?
Have you tried multiple treatments without success? Let your physical therapist know which treatments you’ve tried, including which ones seemed to help and which ones failed. This will prevent you from repeating methods that don’t work for you.
How Will Your Physical Therapist Determine the Cause of Your Lower Back Pain?
Don’t forget those observations you made to prepare for your first appointment! Your physical therapist will count on your observations, as well as a physical examination, to detect the cause of the pain.
Step 1: Initial Questions
First, the physical therapist will ask questions related to your back pain or sciatica and assess your health history. Questions will relate to your age, health habits, and whether you have experienced weight loss, weakness, or sensory changes.
Specific questions that the physical therapist might ask include:
- “What makes your back pain better or worse?”
- “How long have you had the pain?”
- “Was there a mechanism of injury?” (meaning, do you know exactly how the injury occurred or began, such as a sudden injury/accident, or is this an injury that seems to have evolved over time)
- “What are your goals?”
- “How long have you had the pain?”
- “What treatments have you tried?”
While some of these questions may not seem important to a patient, they are key to helping the physical therapist determine the source of pain and the best method of treatment to relieve the pain.
Step 2: Physical Examination
After the initial questions, your physical therapist can pinpoint what’s going on with your lower back through a physical examination. Your physical therapist will use this exam to create an accurate diagnosis and determine the cause of pain.
Once the cause of the pain is revealed, your physical therapist will create a plan to fix the cause of the problem, which can help alleviate the symptoms for good.
“Here at Back in Motion Sport and Spine Physical Therapy, we Fix the Cause — Not just the Symptoms”
During the physical exam, your physical therapist will ask you to perform the following tests:
Step 3: Range of Motion
A “range of motion” test will measure the movement around a specific joint or body part. In order to have a full range of motion, your joint or muscle must have good flexibility. This step may include the use of a goniometer, which is a ruler-like instrument pressed lightly against the outside of a patient’s body to measure the angles of the joints.
A “poor range of motion” means that the joint or muscle is not very flexible, which can contribute to pain and prevent a patient from healing quickly. Luckily, a physical therapist can work with the patient to improve the patient’s range of motion, so that the patient can regain flexibility and make a speedier recovery.
Step 4: Muscle Strength Test
This test will involve contracting the muscles while doing simple movements. Your physical therapist may ask you to perform movements such as pushing down on his or her hand with your leg or pushing down on his or her hand with your quadricep (the muscle group that is in front of the hamstrings).
Physical therapists use a muscle strength grading scale to determine how strong the muscles are and how they are working. The results of this test will give your physical therapist an idea of which strengthening exercises will work best for you.
Step 4: Neurological Tests
Your Doctor of Physical Therapy will also take you through an array of neurological tests. These tests will determine if you have any nerve involvement. Some common tests include checking your reflexes, sensation, strength of your muscles, and neural tension tests.
Step 5: Cause Detection Test
Sometimes the cause of the injury is hard to detect, even with the previous tests. If the cause is not entirely clear during the initial assessment, your physical therapist will give you a plan and treatment based on what is known about the pain or injury.
Over the course of physical therapy, your physical therapist will get a better picture of the cause and adjust the treatment plan accordingly.
For instance, one of the main culprits of ongoing and misdiagnosed lower back pain is limitations in the joints adjacent to the lumbar spine. This includes the thoracic spine and the hips.
When weak or tight in the areas around the lumbar spine, the lower back will usually move too much or compensate.
Here’s a quick video on how the thoracic spine can manifest into lower back pain:
Step 6: Functional Test
The primary goal of a rehabilitation program is to help a patient function as quickly as possible. Functional testing includes various activities that will indicate how well the body is functioning as a whole. These tests are also frequently used to discover why your injury or pain may have started in the first place.
For instance, standing on one leg and reaching down to touch the floor to pick up an object will give your therapist great insight as to how you bend and use your back.
Similarly, if you’re a runner and have lower back pain when running, your physical therapist can discern if you have enough “trail-leg” motion called hip extension. This is a motion of the hip that is needed when running. Poor hip extension in a runner usually causes lower back pain.
These tests will also measure factors such as coordination, muscular balance, flexibility, and strength. Functional tests are also a great indicator of how you’re progressing with physical therapy.
Lower Back Conditions That Your Doctor of Physical Therapy Treats & How They are Treated
Once your condition is determined, your physical therapist will design a plan specific to your condition, the intensity of your condition, the individual components of your condition (such as your history and what makes you feel better or worse), and your lifestyle.
Skilled physical therapists may also perform manual techniques to enhance mobility and relieve pain, such as manual therapy (which can include myofascial release) and spinal manipulation.
If you have the symptoms of any of these lower back conditions, take a look at how a physical therapist can treat your condition:
1. Herniated & Bulging Discs
Herniated and bulging discs have similar symptoms but slightly different causes. Herniated and bulging discs are typically caused by poor posture, spinal hypermobility, and bending improperly.
A herniated disc refers to the soft, jelly-like interior of your spinal disc leaking out into the spinal canal. This condition places pressure on nearby nerves, which can cause pain, numbness, and tingling that radiates from your back into your leg.
A bulging disc occurs when a crack emerges in the exterior of the disc, causing the disc to change its shape and bulge outward. This condition can also place pressure on nearby nerves.
Signs & Symptoms of a Herniated Disc
- Leg pain – most commonly on one side of the body
- Numbness or tingling into the lower extremity
- Weakness/unexplained muscle weakness
- Burning sensation in the affected area
- Pain worse with bending or prolonged sitting
Treatment of a Herniated Disc
When treating a herniated disc, your physical therapist will focus on strengthening the affected area with personalized strengthening exercises. The goal of these exercises is to reduce the disc herniation or bulge while healing the outer layer of the disc called the annulus.
Your Doctor of Physical Therapy should also consider the use of spinal traction, repeated extension-based exercises, and positional distractions to take pressure off the nerve root and get your symptoms out of your leg, buttocks, or thigh.
Once the pain and neurological symptoms are out of your leg, the treatment focuses on healing the disc and figuring out what caused the disc herniation in the first place.
For instance, is your spine hypermobile and in need of more stability?
Do you have faulty bending mechanics secondary to a lack of flexibility?
All of these things need to be considered when designing a proper treatment program to heal a herniated disc.
As your disc starts to heal, your condition will improve and the irritating symptoms should diminish soon.
2. Joint Stiffness
Joint stiffness can be caused by wear and tear of the joints over time, injury, arthritis, or other conditions and diseases.
Signs & Symptoms of Lower Back Stiffness
- Stiffness and pain upon waking
- Stiffness and pain after lying, sitting or standing still for a long period of time
- Lack of muscle flexibility
- Lack of joint mobility
Joint stiffness and lack of mobility go hand-in-hand, so your physical therapist will focus on mobilization and flexibility exercises, heat to increase blood flow to the joints, ice to reduce inflammation, and manual therapy to mobilize the joint and soothe the surrounding muscles.
Your Doctor Of Physical Therapy will also give you specific exercises that will improve your spinal mobility and range of motion.
3. Postural Lower Back Pain
It’s in the name — one of the most common causes of this condition is poor posture. Improper standing, lifting, or sitting for long periods of time can put abnormal stress on the spine which can lead to changes in the structure of the spine.
When postural back pain is left untreated, many patients develop a bulging or herniated disc.
When the spine is restructured from poor posture, the blood vessels and the nerves may become constricted, provoking pain. This condition can also lead to problems with your discs, joints, muscles, and ligaments.
Signs & Symptoms of Postural Lower Back Pain
- Poor posture
- Muscle weakness or tightness
- Poor core stability
- Sedentary lifestyle
- Pain with prolonged sitting
Treatment of Postural Lower Back Pain
Your physical therapist will identify which muscles are contributing to your poor posture and give you targeted strengthening exercises accordingly. Once your postural muscles are strengthened, it will be easier to maintain good posture.
Likewise, your physical therapist will also show you how to sit in your chair properly. If you were not sitting correctly, none of the other treatments may work. After all, this condition is named after poor posture and if you’re sitting incorrectly, you’re going to continue irritating your lower back.
Here’s a quick video on how postural lower back pain can be treated: