What would a Physical Therapist do for Lower Back Pain?  It Depends…

By Paul Gaspar
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Lower back pain continues to be one of the leading reasons why patients visit their primary care physician.  It is so prevalent that hundreds, maybe thousands of treatment approaches have been invented to “cure” it.  If you come across a health care practitioner, self-proclaimed expert, or vendor at the state fair who has a technique which is guaranteed to “cure” your pain, you should run.  Run as fast as you can, even though you may be in pain.

I exaggerate, of course, but the point is that there is no specific treatment which “cures” lower back pain.  That’s because lower back pain is a symptom with many causes and contributing or complicating factors.  It is not a diagnosis, like pneumonia, a staph infection, or diabetes for which a diagnosis can clearly defined by an X-ray, physical exam, or blood tests.  Consequently, the treatment choices for back pain are not as clear cut as prescribing an anti-biotic or blood sugar medication.

So, when asked by a prospective patient what I, as a PT, would do to treat their lower back pain, I say, “It depends.”  Does that mean I am not sure?  Absolutely!  That’s the nature of lower back pain.  There are so many things that could cause, worsen, or prolong the condition that is impossible to say what the best course of treatment is without a thorough history and physical examination.

So…what does that look like?  A physical therapist (PT) should spend ample time with you coming to an understanding of your prior medical history, general health, and the history and character of your back pain.  Anything that has happened between birth and your evaluation visit with the physical therapist could prove to be helpful information, including what you have tried to help your back pain, what has helped, and what has not.

The patient history should help the PT prioritize what to look for in a detailed examination of your spine and overall musculoskeletal health.

Here are a few items that oftentimes rise to the top of the list:

  • Back Range of Motion
  • Back Strength/Stability and Overall Fitness
  • Postural Alignment
  • Hip and Leg Flexibility
  • Coordination and Motor Control
  • Nerve and Muscle Exam
  • Examination for Spasm
  • Mechanical spine exam to provoke or alleviate symptoms
  • Special tests for individual spine segment mobility and stability
  • Screening for non-physical variables that may affect back pain

By corroborating findings from the patient history, the physical exam, and relevant scientific literature, the PT will make an informed about the best treatment course.As a general rule, PT for acute pain will be a little less aggressive in terms of exercise intensity though movement will usually be highly encouraged.  With chronic lower back pain, passive treatments may serve as an effective adjunct to active, functional, and restorative treatments, but are usually not the focus of an effective physical therapist’s approach to lower back pain.Stay tuned for the next blog and find out what treatments PTs have found most effective for different types of lower back pain.

Paul Gaspar
Author: Paul Gaspar