Article Reviewed & Updated on 9/21/2022
Medical Reviewer: Kari Haberman
Although statistics vary from study to study, as many as 80% of adults have suffered from back pain at some point in their lives. Causes vary and can sometimes elude identification, but if a patient with back pain doesn’t get relief within a week or two, doctors often refer the sufferer to a physical therapist.
Physical therapy can be a non-invasive, holistic approach to getting relief for back pain sufferers.
Rather than employing pain killers for extended periods or resorting to surgery, turning to physical therapy can be a conservative first step. Most causes of back pain can benefit from physical therapy.
What Causes Back Pain?
Back pain causes come under three categories: instability, spinal stenosis, skeletal stiffness, or inflexibility. Often a cause from one category leads to secondary causes from another category.
Stiffness due to osteoarthritis, for example, can lead to muscular instability, and instability can cause bulging discs ( spinal stenosis). A bulging disc can cause muscle spasms and worse posture. A physical therapist can help put your body back in order.
1. Instability
The most common cause of back discomfort is posture and muscle instability.
When deep spinal muscles or abdominal muscles weaken, other muscles become tight and overworked. Poor muscle tone in a person's core interferes with proper posture, which stresses both skeletal and muscular systems.
Muscle spasms and tightness can be painful and cause ligament damage. Muscle weakness and strain and poor posture can lead to the second category of back problems, spinal stenosis.
2. Spinal Stenosis
Between the vertebrae in the back, discs of cushion facilitate movement and prevent bone from touching bone. Discs have a tougher outer layer and a jelly-like substance inside to work as shock absorbers and allow movement.
When the discs expand too far in either direction, they press on nerves and cause sciatic pain. Pain often shoots into your hip and down your leg. Trying to prevent the pain, a patient may favor or strain muscles and wreak havoc with their posture.
3. Inflexibility
Spine stiffness caused by osteoarthritis or other disease is the third category. More typical in the elderly, stiff joints limit mobility, which leads to muscle weakness. Without good muscle, posture begins to erode, discs may bulge, and muscles hurt.
No matter what started your back pain, a physical therapist can usually help. When you arrive at a physical therapist’s office, evaluation comes first. Your therapist will examine you and ask many questions to determine your pain's cause or causes.
You will be asked to move your body in prescribed ways to measure your range of motion and determine which movements cause you pain. You will describe your pain, letting the therapist know whether the pain is acute or aching, sporadic, or steady.
From the information gathered, your physical therapist will customize a course of therapy to relieve your symptoms and teach you how to prevent future back issues.
The routine might include heat and cold therapy, electronic stimulation, manipulation and mobilization, repeated motion, and exercise.
What Happens in Physical Therapy?
1. Heat and Cold
Most PT sessions start with moist heat. Applying hot, moist blankets or pads to your back increases blood flow and relaxes the muscles about to be worked. Enjoy a brief nap and enjoy the warmth. After your session, you may feel some pain, and there may be some swelling in joints. Applying ice reduces inflammation and relieves pain before you go off to your next activity.
2. Electronic Stimulation
Muscles that have gone unused for a while are weak. Your therapist or aid may attach sticky-backed electrode terminals and hook you up to a TENS machine to begin strengthening them.
By sending pulses of electricity, the muscle starts to work. You will feel a tingle but no pain. TENS treatment also stimulates blood flow. Because electronic stimulation helps reduce pain, you may get a treatment at the end of a session for that purpose.
3. Manipulation and Mobilization
Some therapists use the same kind of manipulations chiropractors use. These movements are short rapid thrusts that adjust your skeleton.
All physical therapists employ mobilization or repeated slow, gentle motion. Before having you work weak muscles yourself through exercise, a therapist or assistant will move your body for you to lightly engage the muscles and gently adjust your spine.
They might repeat a motion 10 or 15 times. Manipulation may include manual traction if you have bulging discs.
By gently pulling your legs or from behind your head, a physical therapist separates your vertebrae slightly to allow discs to relax back into a correct shape. The treatment feels wonderful because the pressure comes off the nerves that are causing you pain.
4. Exercise
Since so many back problems happen because of weak muscles and incorrect posture, exercises can be the most useful in eliminating pain and preventing future back problems. Movements will stretch tight muscles, strengthen muscles, and correct posture. Some typical exercises include:
- Lying with your knees up and tilting your knees to one side and then the opposite side.
- Lifting your leg slightly off the bed for a few seconds at a time
- Standing or sitting tall in a chair with correct posture for a count of ten and then relaxing
- Pulling on elastic bands to work various muscle groups from your legs and arms to the abdomen and, back
- Standing with your back to the wall and sliding up and down
- Lying on or rolling on big rubber balls
Back Pain Tips from a Physical Therapist
Homework
Usually, you see a physical therapist a few times a week. Between sessions, it’s important that you follow any instructions your therapist gives you. You will probably be asked to do some or all the exercises and stretches you have been taught.
You might use a heating pad or ice before and after the workout. Following the instructions will allow you to progress much more quickly. Once you finish therapy, continuing to repeat the exercises will help keep your back healthy and prevent future problems and pain.