physical therapy; the preferred treatment for lower back pain
BY: DR. AMIR KAZEMI
Low back pain is routinely treated by physical therapists. It is a common health problem and a major cause of disability. Low back pain can be acute, sub-acute, or chronic. In many cases there is not a significant traumatic event to identify, and therefore, the distinct cause of lower back pain is often unclear. Several risk factors such as occupational posture, depressive moods, obesity, body height and age can significantly contribute to its cause. According to the World Health Organization, lower back pain is “not a disease but a constellation of symptoms”. The symptoms of low back pain vary a great deal. The pain may be dull, burning, or sharp that is felt at a single point or over a broad area. There may be muscle spasms or stiffness and may spread into one or both legs.
There are 3 different types of low back pain:
1. Acute – pain lasting less than 3 months
2. Recurrent – acute symptoms come back
3. Chronic – pain lasting longer than 3 months
Despite popular belief, imaging tests, such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are not helpful for recovery. Imaging results can be misleading since it may not match the biomechanical deficits that are often identified during the physical therapy exam. For example, a study in 2015 (1) compared patients who received an MRI first vs physical therapy first for low back pain, the patients who received an MRI first spent on average $4,793 more; while the outcomes were similar in each group. Your physical therapist will perform a thorough evaluation that includes:
• A review of your health history.
• Questions about your specific symptoms.
• A thorough examination that includes assessing the quality and quantity of your movements, biomechanical deficits and any movement behaviors that might put you at risk for delayed recovery.
• Tests to identify signs or symptoms that could indicate a serious health problem, such as broken bones or cancer.
• Assessment of how you use your body at work, at home, during sports, and at leisure.
Low back pain may have one or multiple mechanical causes. Therefore, treatment should be tailored for specific symptoms and conditions. Once the examination is complete, the physical therapist will evaluate the results, identify the specific factors contributing to the problem and design an individualized treatment plan.
Treatments may include:
• Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues
• Specific/targeted strengthening and flexibility corrective exercises
• Education about how to take better care of your back
• Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions
• Assistance in creating a safe and effective physical activity program to improve your overall health
• Use of ice or heat treatments or other modalities to help relieve pain
The course of treatment can be anywhere from 4-6 weeks depending on the response of the patient to treatment and patient goals.
Physical therapists play an important role not only in treating persistent or recurrent lower back pain, but also in preventing it and reducing recurrence. Physical therapists can teach how to use the following strategies to prevent back pain:
• Using good body positioning at work, home, or during leisure activities.
• Keeping loads close to your body during lifting.
• Asking for help before lifting heavy objects.
• Maintaining a regular physical fitness regimen—staying active will prevent injuries.