Low back pain (LBP) is an epidemic. People of all ages suffer from various levels of low back pain that negatively affects life, and in some cases prevents you from carrying out everyday activities.
The commonly known treatment approach for low back pain, especially acute and sudden onset pain, is to take pain killers.
But the American College of Physicians recommends non-pharmacological treatment in acute or subacute stages.[i] If medication is desired, then NSAIDs and muscle relaxants are preferred.
There have been multiple studies recommending against the use of NSAIDs and opioids[ii] especially before physical therapy and alternative pain management approaches.
Research shows that a lot of back pain patients can recover with physical exercises, a modification of activities and other such remedies.[iii]
A physical therapist is usually the health care expert who can prescribe you the appropriate dose and type of treatment for low back pain.
In this article, we’ll discuss five approaches that physical therapists (PTs) commonly use to treat low back pain. We’ll also link some research that supports the statements so you can check them out.
Let’s dive right in!
Non-Pharmacological Treatment of Low Back Pain With Physical Therapy
Several causes of low back pain can be efficiently treated with physical therapy. Here are five different approaches PTs might use to help you reduce and eliminate your LBP:
1. Postural Retraining
Low back pain is largely affected by our postures.
That’s not so much because of the excessive pressure on the different regions of the vertebras (small bones of your spine) as it is due to the inactivity of core / abdominal muscles.
These muscles are the stabilizers of the spine. And prolonged inactivity of them results in reduced strength and thus intermittent low back pain.
Prolonged sitting in a slouched position can result in a weaker core and thus LBP. [iv] Similarly, bad lifting posture can result in low back pain as well. Here, ‘bad posture’ is defined as lifting an object by flexing your hips and the back much more than the knees. Continuing to do these activities can aggravate your LBP.
Source: dreamstime.com
That’s because this position puts excessive pressure on the back – lifting a ten-pound object puts a hundred-pound pressure on your spine. Moreover, people tend to pull/ injure muscles when they try to suddenly lift leading to back pain because of a muscle strain.
That’s why a primary approach for treating low back pain in physical therapy is to retrain your posture and teach proper sitting and lifting ergonomics.
Your PT will likely use manual therapy or a heating pad initially and prescribe a muscle relaxant to treat the immediate symptoms. And then teach correct postures to perform the same functions so that your back is in an optimal position during all activities. [v]
People that don’t learn to sit, stand and move the right way after the first back pain episode often get chronic low back pain and suffer for years. So postural retraining can be impactful when started at the right stage. [vi]
2. Modification of Activities
Mechanical low back pain is that which arises from spinal bones, soft tissues, joints and the surrounding structures. It accounts for approximately 97% of low back pain cases.[vii]
Often the cause of this pain is an injury or an extended non-traumatic stimulus that puts the spinal structures under undue pressure.
For example, a baseball player may experience low back pain because of an underlying mechanical cause that is aggravated by the excessive twisting of the back during pitching. Or it could be because the player isn’t activating the core muscles and overworking the spinal muscles as a result. [viii]
In cases where the cause of LBP is clearly due to a faulty activity, your PT will treat it by modifying your activities.
This could include an extensive rehab to prepare you to return to the sport and stay injury-free. Or your PT could prescribe you a home exercise program and periodically check in to measure the progress.
3. Treat Root Cause of Pain With Mobilization
Oftentimes, low back pain is classified as non-specific. This means that there are no known underlying pathologies such as an infection, fracture or congenital deformity that is the cause of LBP. This pain can radiate as well and move into the upper back or the legs.
In these cases, the cause can be a traumatic injury or a muscle strain. Treating LBP with physical therapy and exercise requires percision and experience. Here, your PT will identify the root cause of your pain and then treat it.
So if it’s a muscle strain then your PT will do soft tissue mobilizations along with applying heat and stretching the muscles. [ix]
Root causes of LBP can be osteoarthritis or a herniated disk or other such causes. Again, PTs will treat this pain with exercises and mobilizations that reduce the primary pathology.[x] Doing so eliminates the radiating pain (the phenomenon is called centralization) and eventually reduces the LBP as well.
4. Stretching and Strengthening
Tightness of muscles such as hamstrings and erector spine muscles can result in LBP. On the other hand, weakness of Transverse Abdominis (TrA) muscles, lumbar multifidus and other stabilizers also leads to back pain.[xi]
Source: learnmuscles.com
Therefore a stretching and strengthening regimen can be effective in reducing LBP. And this approach is widely used in physical therapy for the appropriate patients.
Firstly, your PT will conduct an examination of the muscles strength and flexibility and then devise a plan to balance the structures so that the correct muscles are activated during daily activities.
The core strengthening exercises are often performed in functional positions rather than classic ab exercises that you most commonly see in commercial gyms – although these are also used.
So for example, your PT might train you to maintain the neutral position of the lumbopelvic-hip complex. This will work on the coordination of the deep and superficial trunk muscles. [xii]
5. Selective Electrotherapy as an Adjust to Exercise
Electrotherapy in physical therapy includes transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound and interferential currents (IFC) to name a few.
These are used as an addition to the physical therapy active exercise and manual therapy regimen.
Research has found that using electrotherapy to treat low back pain can result in reduced pain and a lower intake of medicines.[xiii]
These electric modalities work by either activating the body’s natural pain killers or generating heat to relax the muscles and increase blood flow to the region to accelerate healing.[xiv]
Your PT will likely perform manual therapy or massage and prescribe you a home exercise program along with electrotherapy. There’s not enough literature to support the use of electrotherapy alone, that’s why we always pair it with other therapeutic approaches.
Types of Low Back Pain
Low back pain can be localized in the back region or it could radiate to the buttocks or even down the legs. The intensity of pain and the area affected can help your PT in identifying the cause of pain and treating it accordingly.
In general, LBP is divided into three main categories:[xv]
- Acute LBP: Pain that comes on suddenly and can last from a few hours to up to 4 weeks.
- Sub-acute LBP: Pain that lasts for 4 weeks to 12 weeks. The intensity of the pain can change during this time and you may even experience small windows of no pain.
- Chronic LBP: Pain that lasts for longer than 12 weeks. Some people even suffer for years with some periods of no pain. Nearly 1/3rd of people suffering from back pain have chronic pain.
Reduce Your Low Back Pain With Physical Therapy
Physical therapy can be highly effective in reducing LBP. Several studies have shown its effectiveness in helping patients with acute and chronic back pain.
When deemed safe, physical therapy guidelines for LBP recommend that you avoid bed rest and stay active.[xvi]
Other pain management approaches include postural retraining, activity modification, strengthening of the core while stretching of the supporting spinal structures and so on.
If you suffer from back pain then you should explore physical therapy. Reach out to a PT near you or contact us for a consult.
[i] https://www.acpjournals.org/doi/full/10.7326/M16-2367?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
[ii] https://link.springer.com/article/10.1007%2Fs00586-017-5099-2
[iii] https://academic.oup.com/ptj/article/90/8/1111/2737950?login=true
[iv] https://pubmed.ncbi.nlm.nih.gov/30380507/
[v] https://www.hindawi.com/journals/prm/2021/5581491/
[vi] https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr171071
[vii] https://pubmed.ncbi.nlm.nih.gov/18973732/#:~:text=Common%20causes%20of%20mechanical%20back,specifically%20targeted%20toward%20different%20causes.
[viii] https://www.tandfonline.com/doi/abs/10.1080/15438627.2017.1282361
[ix] https://journals.lww.com/jaaos/fulltext/1999/07000/muscle_strain_injury__diagnosis_and_treatment.6.aspx
[x] https://pubmed.ncbi.nlm.nih.gov/29371112/
[xi] https://www.sciencedirect.com/science/article/abs/pii/S0161475412000668
[xii] https://pubmed.ncbi.nlm.nih.gov/26418868/
[xiii] https://pubmed.ncbi.nlm.nih.gov/21971895/
[xiv] https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1525-1403.2002.02036.x?__cf_chl_jschl_tk__=pmd_4As7w0.B8stZ.YLiQe_A6EAU.niijoKRy_DDuXVpy.M-1635254880-0-gqNtZGzNAlCjcnBszQw9
