Back pain is one of the most common complaints among physical therapy patients. Some have mechanical causes, while others have acute back pain due to an injury or internal cause.
Since it’s such a common occurrence, there are multiple treatment options available for it.
The American College of Physicians guidelines recommend trying non-pharmacological treatment for chronic back pain before considering medication and surgery. That includes exercises, physical therapy, modalities, active rest, and activity as tolerated.
Physical therapy offers excellent long-term results when it’s done right. If you’ve been having back pain and are thinking about going to a physical therapist for treatment, this article will tell you about what you can expect from physical therapy for back pain.
13 Things You Can Expect at Physiotherapy for Back Pain
Physical therapy for back pain is usually given in outpatient clinics. You perform some of the exercises and treatments with the physical therapist and do the rest of them at home.
Here’s what you can expect in a physical therapy program for back pain:
1. A Detailed History and Physical Exam
Physical therapy treatments always begin with a detailed history and physical exam. We check your functional activities, mechanism of injury, the onset of pain, radiation of pain to the legs or upper back, medical history, aggravating factors, and presence of chronic diseases.
Knowing all these factors is vital because they influence our exercise prescription.
For example, research tells us that most acute cases of back pain resolve on their own without excessive treatment. And that exercises don’t have a superior effect over the usual treatment regimen i.e. active rest for acute and subacute pain.
However, such patients can benefit from prehabilitation to reduce the possibility of another back pain episode. In case of acute pain episodes, we usually educate and reassure patients about the high possibility of back pain resolving on its own and focus on preventive exercises once the pain intensity decreases.
On the other hand, chronic cases need a multidisciplinary approach.
So depending on your case, you can expect your physical therapist to give you a treatment plan spanning weeks for treating back pain and also prescribe some preventions.
2. Explanation of the Problem
Your therapist will provide an evidence-based explanation of your condition, discuss possible treatment options, and answer any questions you might have about your condition.
This plays a significant role in improving patient satisfaction and reducing some of your anxiety around back pain and its impact on your function, work, and activity levels.
3. Not Just Stretches
Stretches play an essential role in back pain treatment. Research supports their use specifically for improving hip muscle flexibility and low back stability.
But some healthcare providers and companies have overblown the benefits of stretches. So patients believe that stretches alone can get them to recovery. You should know that’s not the case, and expect a treatment plan in which stretching is just one component.
You can expect hip and lower limb stretching exercises in your physical therapy rehab program for back pain. But these are almost always used along with strengthening, active rest, postural reeducation, and other treatment techniques. (Reference)
4. Not Just Massage
Massage has a psychological (related to perception and thinking) and physiological (functional) role in treating back pain. It provides short-term pain relief for patients with chronic back pain.
Similarly, patients with acute and subacute back pain find pain relief with massage and acupuncture but these don’t directly improve function in most patients.
Research suggests that massage has psychological effects and alleviates feelings of pain through the activation of C-tactile fibers in the skin.
Since it helps patients, you can expect your physical therapist to massage your back and advise you to do the same at home for temporary pain relief. But these aren’t included in every treatment plan.
5. Not Just Belts and Lumbar Support
Patients with back pain due to a disk problem are often prescribed a lumbar support belt. It restricts your movement and prevents you from performing painful activities or moving into a painful range of motion. It’s supposed to provide your low back region with the support that your muscles usually provide.
Although it’s widely used, it doesn’t have high-quality evidence backing its use for patients with acute or subacute back pain. It might cause more harm than good in some cases.
You can expect to be prescribed a lumbar belt but don’t be surprised if you don’t. It’s useful in only a handful of situations.
6. Temporary Restriction of Activities
One of the most popular things included in the physiotherapy program for back pain is temporarily avoiding certain activities, usually those that load the painful muscles or overstimulate your painful spots.
You must remember that it’s only temporary. It’s highly unusual for a physical therapist to tell you to stop doing a certain activity forever. You should ask your PT for an explanation for why you can’t do the things they’re asking you to avoid and also for a timeline for when you can return to the activity.
7. Strengthening Exercises for Core and Back Muscles
Core stability is essential for proper load distribution across your back and hips bilaterally. Studies have found that a majority of patients suffering from non-specific low back pain have muscle weakness around their hip, pelvis, and core. Because of that, non-postural muscles (such as the ones in the upper thigh) are overactive and cause pain. (Reference)
You can expect your physical therapist to assess your core muscle strength and core engagement during your assessment and periodically over future visits. Your physical therapist might prescribe exercises to balance load equally across the core and hip.
These can include:
- Bridging
- Cat and camel pose
- Pelvic tilts
- Planks
- Bird dog (get on all fours and slowly lift one arm and the opposite leg in the air)
Your physical therapist will start with just a handful of strengthening exercises and slowing progress as per need.
8. Progressive Loading and Increase in Exercise Intensity
Increasing the intensity of exercises is the key to effective recovery. You can expect your physical therapy for back pain to get more difficult with time but never too much to reignite your pain.
The goal is to strengthen your body to handle your load and activity levels so you can return to enjoying the things you love without worrying about back pain.
9. Posture Correction if Required
Mechanical back pain is defined as pain that arises due to a known external factor (usually bad posture, occupational reasons, or an injury). It comes and goes depending on its aggravating factor and is usually acute, which means that you’ll feel a lot of pain suddenly and it’ll slowly decrease if you remove the factor that caused it.
Not all posture is necessarily bad. Our bodies are quite adaptable and adjust to a variety of postures and still function without pain.
Some postures, however, excessively overload the wrong muscles or joints and cause back pain. Prolonged sitting with a hunched back or without back support, lifting heavy objects with a bent back, and excessive twisting of our back (similar to what golf players or baseball players do) are some of the postures that cause mechanical back pain.
You can expect your physiotherapy program for back pain to include posture correction exercises if your back pain is due to a mechanical cause. These corrective exercises are progressed over time to ensure long-term improvement.
A good physiotherapist won’t give you instructions such as “just sit up straight” because such vague instructions don’t work most of the time.
Instead, we use cues to help you remember to correct your posture from time to time. These cues can be to
- Bring your chest out while you sit
- Remember to maintain your natural spinal curves (after showing you a picture of what that looks like and also helping you feel what normal curves feel like),
- Use an ergonomically appropriate office chair for your height and body type and sit such that your shoulders and most of your back is touching the back support,
10. Active Rehab
A common misconception of most patients who come to physiotherapy clinics for the treatment of their back pain is that the physiotherapist will use their magic hands and shoo away the back pain.
But that’s not the case. You should be ready for “active rehab”. It means that the greater portion of the rehab will involve active participation from you. Only a small portion will be passive therapy such as massage, electrotherapy, soft tissue techniques, mobilizations, and hot packs.
Active rehab is great for long-term improvement. It empowers you to take rehab into your own hands and have greater control over your outcomes. Remember, the more effort you put in and the smarter you work, the better recovery you can expect from physiotherapy for back pain.
11. Identification of Root Cause and Elimination of It
An important step of the assessment phase is determining the root cause of your back pain. Knowing that gives us the best chance of designing the most effective treatment program.
We talked about mechanical pain earlier in this article. That’s due to external causes. But there are internal factors as well such as tumors, surgery, disk herniation, or osteoporosis that cause back pain.
You can expect your physiotherapist to ask you many questions to identify the factors responsible for your back pain.
12. Passive Techniques and Modalities
You can expect your physical therapist to apply pressure to various regions of your back while treating your back pain. These are called spinal mobilizations and are usually a common part of the physical therapy rehab program.
However, the recommendation to use mobilizations for acute or subacute pain comes from low-quality studies. The current evidence suggests that it isn’t superior to exercise and the usual treatment regimen in terms of improving function and reducing pain in acute and chronic back pain management.
Most physical therapists also use modalities such as therapeutic ultrasound and superficial heat so you can expect that in physical therapy programs for back pain. Superficial heat through heating pads helps with pain relief immediately after a back pain episode (4-5 days) and reduced disability.
You might also be prescribed modalities such as TENS, EMS, short wave diathermy, and taping. Although these are beneficial for some acute pain cases, the research on their effectiveness is inconclusive.
The best strategy is to ask your physical therapist why they’re prescribing a specific modality to you and try to understand the mechanism of how that modality will possibly help your back pain.
A good PT should be able to explain to you the process in simple-to-understand terms. And even tell you about previous patients’ improvements and show you case studies from their own experiences.
13. Home Exercise Program
Physical therapy treatment for back pain is incomplete without a home exercise program. So expect to get one during the early days of your treatment.
These programs generally include exercises, prevention/ avoidance of aggravating factors, and guidance to help you manage flare-ups.
In Summary
Back pain is one of the most common reasons for seeking physical therapy. But even though it’s highly prevalent, the treatment for each patient looks different from others because everyone has unique factors that influence their outcomes.
Are you suffering from back pain? Contact us for a tailored exercise program or leave us a message if you have questions about your rehab.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.
