Are you one of the 80% of people who will experience some form of low back pain within their lifetime? If so, you have many treatment options. It can be confusing to determine where to start. Physical Therapy as a first line intervention for low back pain has been shown to decrease total medical costs by 19% compared to injection first treatment, and by 75% compared to surgery first treatment (3). In fact, those who began Physical Therapy treatment within 15 days of diagnosis incurred lower treatment costs than those who began later (3).

Physical Therapy Management for Low Back Pain

Low back pain comes in a number of different forms for a number of different reasons. As physical therapists, we look at different factors that may predispose you to your current episode of pain and loss of function including:

• Range of Motion: local and global range of motion deficits may be predisposing you to low back pain during your daily activities
• Strength: core and lower extremity strength can play a factor in low back pain
• Exercise Routine
• Work/Home/Recreational Lifestyle: demands of your daily life
• Movement Patterns and habits

Treatment strategy includes a balance of rest, stretching, exercise, modalities, and time. We can help you find the right balance and will likely include many of the following components:

• Manual Therapy: 
  • Joint mobilization: Gentle techniques to joint capsule to relieve pain and increase range of motion
  • Soft tissue mobilization: Often referred to as “massage” of muscles and tendons to help increase blood flow, decrease tissue sensitivity and promote a reduction of pain and increase in function

• Graded Home Exercise Program: 
  • Range of motion exercises: Mobility and stretching to soft tissue structures. May be passive or active depending on the timeline of your condition
  • Resistance training: Progressive strengthening to weakened tissues to increase your body’s capacity to function properly. This can include exercises using body weight, free weights, machines, or isometric exercises to allow you to move normally
  • All exercises are tailored to your specific condition and clinical presentation

• Daily Living Recommendations:
  • Activity modification
  • Home/Office ergonomic setup modifications
  • Positional considerations for lifting
  • Sleeping positional modifications
  • Walking/biking program

• Modalities: 
  • Electrical stimulation: Often used to transmit electrical impulses through the skin to reduce pain signals to the spinal cord and increase blood flow to surrounding tissues to accelerate the body’s natural healing process
  • Ultrasound: Can be used to target a decrease of inflammation as well as an increase of deep heat to surrounding tissues
  • Heat: May be helpful in promoting blood flow to an area and relieving areas of increased muscular tightness or spasm associated with your low back pain
  • Ice: Often used as a pain reliever and and in cases of acute injury or increased inflammation

• Referral to other healthcare professionals: While we will do our best to help you decrease pain and improve function in a conservative manner, there are cases in which referral to other specialists is necessary

Common Low Back Diagnoses

It is important to note that many of these conditions can occur in concert with each other and may or may not be the exact cause of your pain. People with similar MRI/X-Ray findings will often present with different symptoms or even have no symptoms. A Physical Therapist can help you determine clinically relevant findings based on your presentation and develop an approach for your specific issue.

• Disc Degeneration: Natural occurrence of aging causing loss of hydration and height of intervertebral discs in the spine

• Disc Herniation: Outer fibrous rings of the intervertebral discs lose structural integrity due to chronic repetitive strain or acute trauma. Can cause neurological symptoms due to “pinching” on exiting nerve roots

• Sciatica: This term refers to sharp pain that can radiate into the buttock, through the back of the leg and even down into the foot. This is caused by compression of the sciatic nerve or one of its nerve roots originating in the lumbar spine. This compression can be caused by several factors including
  • Disc bulge/herniation: See above
  • Piriformis syndrome: The piriformis is a muscle located deep into the buttocks that can cause entrapment, compression, and irritation of the sciatic nerve
  • Osteophytes: Osteophytes are bone spurs that can form on the vertebrae which can also cause compression/irritation of the nerve roots at the lumbar spine

• Lumbar Facet Syndrome: The lumbar facet joints along with the intervertebral disc forms the “intervertebral joint”. Wearing down of discs can affect the structure of the facets and vice versa. This can cause localized and referred low back pain

• Stenosis: Often occurring with a normal aging process, stenosis causes a narrowing of the foramen where neural and vascular structures live in the spine. Symptoms often include increased back and radiating lower extremity pain after standing/walking for prolonged periods and is relieved with sitting and rest

• Spondylolysis/Spondylolisthesis: A spondylolysis occurs when there is a crack or fracture in one of the vertebrae that make up the vertebral column. This can progress to a spondylolisthesis which causes the vertebrae to slip on one another. This can occur in older adults as a degenerative process and is also commonly found in athletic adolescent populations. Depending on the grade, this can lead to more serious neurological issues

• Osteoporosis: This occurs when the body begins losing bone faster than it can generate it, causing a loss of structural integrity. While this is not exclusive to the lumbar spine, it can predispose someone to compression fractures of the vertebral bodies

If you’re suffering from low back pain, don’t hesitate to schedule a consultation with one of our physical therapists. We will assess your specific situation and tailor a treatment plan for you.

Disclaimer

The information in this article is intended for informational and educational purposes only and should not be taken to be the provision or practice of Physical Therapy services. It is not intended to delay or substitute diagnosis or care from a Physical Therapist or other healthcare professional.

Resources

1. Dieleman, J. L., Cao, J., Chapin, A., Chen, C., Li, Z., Liu, A., … & Murray, C. J. (2020). US health care spending by payer and health condition, 1996-2016. JAMA, 323(9), 863-884.

2. Kim, L. H., Vail, D., Azad, T. D., Bentley, J. P., Zhang, Y., Ho, A. L., … & Ratliff, J. K. (2019). Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain. JAMA network open, 2(5), e193676-e193676.

3. The Moran Company. (2017). Initial Treatment Intervention and Average Total Medicare A/B Costs for FFS Beneficiaries with an Incident Low Back Pain (Lumbago) Diagnosis in CY 2014. Prepared for APTQI.

4. Davis, M. A. (2012). Where the United States spends its spine dollars: expenditures on different ambulatory services for the management of back and neck conditions. Spine, 37(19), 1693.