By: Rob D. Dickerman, DO, PhD
Patients suffering from most types of low back pain are often referred for physical therapy for four weeks as an initial conservative (nonsurgical) treatment option before considering other more aggressive treatments, including back surgery. The goals of physical therapy are to decrease back pain, increase function and teach the patient a maintenance program to prevent future back problems.
Common forms of physical therapy include:
- Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ice packs and electrical stimulation. For example, a heating pad may be applied to warm up the muscles prior to doing exercising and stretching, and an ice pack may be used afterward to sooth the muscles and soft tissues.
- Active physical therapy, which focuses on specific exercises and stretching. For most low back pain treatments, active exercise is the focus of the physical therapy program.
This article focuses on active physical therapy and exercise as a means to help recover from back problems and prevent or minimize future flare-ups of low back pain.
Exercise Benefits for Low Back Pain
Lumbar spine (low back) stability is largely dependent on the supporting abdominal (stomach) and low back musculature. The abdominal muscles provide the initial stabilizing support through their ability to generate pressure within the abdomen which is exerted posteriorly on the spine, thus providing an anterior support column (from the front of the spine). The low back muscles stabilize the spine from the back and lead to posterior support. Simply stated, the bony spine and discs are surrounded by muscles, and the stronger these specific muscles are, the less stress is placed on the discs and joints of the spine. The patients should develop a ‘belt’ of muscle around their spine.
There is a substantial amount of medical literature supporting specific physical therapy exercises for the treatment of low back pain. While most episodes of low back pain are self-limiting and will get better on their own, active exercise plays an important role in helping reduce the patient’s pain and improving subsequent function in patients with low back pain. An ongoing exercise program also reduces the likelihood and severity of future occurrences of low back pain.
Physical Therapy Before and After Back Surgery
There is substantial evidence supporting the benefits of physical therapy and exercise both before and after back surgery. The strength and stability that physical therapy provides can significantly shorten a patient’s recovery time after surgery. Physical therapy and exercise is considered an important part of most back pain patients’ treatments, including those undergoing non-surgical and surgical care. This is because patients with low back pain are most likely to recover when the patient is in optimum physical condition. Unless there is a contraindication for physical therapy or a patient requires emergency surgery, most patients are advised to undergo a trial of physical therapy prior to considering back surgery.
For many patients with low back pain, it is usually advisable to first consult a physician who can diagnose the patient’s condition and rule out any serious contraindications for physical therapy, such as a fracture or tumor. Many patients find it most helpful to be monitored by a physical therapist to ensure follow through and avoid problems. Once the initial phase of therapy is complete, those patients who continue to follow an exercise program are often the most successful in managing their low back pain.