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2021 Year In Review Part 1: Physical Therapy For Back Pain

Every week we send out a post to educate you about common injuries and painful disorders, and if you read our posts regularly, you may have noticed a recurring theme: seeing a physical therapist first and fast is the best choice you can make if you’re experiencing pain that’s holding you back from enjoying life. We emphasize this point because we believe it’s the most important message our patients should be aware of, and we regularly provide examples of why this is true and evidence to support it. With the end of the year approaching, we’d like to bring this message to front–and–center one last time by summarizing the posts that have described the four most common regions in the body where pain occurs and how physical therapy can help.

To kick off these posts, we’re going to look at the back.

Most of us are bound to experience back pain at some point

While it’s not a complete guarantee, there’s a strong chance that you’ll experience back pain at some point in your lifetime. About 8 of 10 people are expected to encounter low back pain at least once, making the spine the most common location for pain in the body. How you experience low back pain and how it affects your life will depend on your age, habits, and health, and it’s important to realize that some cases can be avoided while others are primarily out of your control.

For children and adolescents, most cases of back pain result from strains and sprains of the muscles and ligaments of the back, which can occur either from a single injury or from damage that accumulates over time. Children that participate in various sports year–round without taking enough time to recover are one patient group that has a higher risk for low back pain than others. There’s also been an increased rate of back pain in adolescents due to the obesity epidemic, as the extra weight puts stress on the immature spine and throws off posture, which forces the lower back to work harder to stay upright.

As the body ages, other problems arise due to age‐related changes that are often out of one’s control. One of the more common changes that occurs with age is that the intervertebral discs that rest between the spinal bones (vertebrae) eventually begin to dry out. These discs are soft and squishy earlier in life, which allows them to effectively absorb shock. But over time they lose some of their height and strength and can no longer take on as much impact. Other changes that usually start to occur in middle age include a narrowing of the space surrounding the spinal canal and a weakening of the joints that connect the vertebrae together. As a result of these age‐related changes, several other conditions become more likely to develop, such as:

  • A herniated disc: occurs when some of the softer jelly‐like substance of the intervertebral disc pushes out through a tear in its tougher exterior, which may or may not cause symptoms
  • Spinal stenosis: the name for the narrowing of the spinal canal, which can put pressure on the spinal cord and lead to pain
  • Spondylosis: a general term used to describe any pain related to age‐related changes in the spine, which becomes more common with aging

Osteoarthritis and osteoporosis also become more common in later life. Osteoarthritis occurs when the protective cartilage that surrounds the vertebrae thins away, which makes the bones more vulnerable to rub against one another, often resulting in pain. Osteoporosis is a condition that causes bones to become weak and brittle, which increases the chances of fractures in the back. Further adding to the potential for back pain in older age is the loss of flexibility that many individuals experience. Reduced flexibility often has a negative impact on activity levels, which can create a vicious cycle of less movement and a higher risk for injuries like back pain.

Why physical therapy is the best solution for all causes of low back pain

If you find yourself affected by an episode of low back pain that doesn’t improve on its own, you’ll likely need treatment, and physical therapists are best equipped to provide this for you in a safe and effective manner. Physical therapy uses a variety of movement‐based interventions to address low back, some of which are executed independently by the patient, with guidance, and others that the therapist carefully performs on the patient. The ultimate goal of each component of treatment is to teach patients how to move better in order to reduce their pain levels, increase function, and prevent further recurrence.

Seeing a physical therapist as the first point of care for low back pain can also help patients avoid other expensive or unnecessary interventions in the future. Research has shown that individuals who undergo early physical therapy are less likely to have surgery or injections for their pain, and it has also been found to reduce costs, healthcare use, opioid use, and improve health care efficiency.

Each low back pain treatment program is tailored specifically to the patient’s needs, abilities, goals, and preferences, but there are certain features that are common in most plans. A typical treatment program for low back pain will consist of the following:

  • Passive interventions (performed by the therapist)
    • Ice and/or heat therapy
    • Ultrasound
    • Manual (hands‐on) therapy
  • Active physical therapy (performed by the patient)
    • Stretching exercises for the buttocks, back, spine and hamstrings are helpful for keeping joints flexible and should be done twice a day
    • Strengthening exercises are needed to build the muscles in the back and core, and should be done for 15‐20 minutes every other day
    • Low‐impact aerobic exercises like walking, biking, and swimming are also important and should be done for 30‐40 minutes, three times a week
    • Education: physical therapists will also provide tips and guidance on how to improve your posture and make other necessary changes that may be contributing to your pain

Low back pain is one of the most common conditions in all of healthcare, and it often becomes a burden for the countless individuals who are affected. But if you see a physical therapist first and fast, you’ll greatly improve your chances of having a successful outcome with lower costs and a reduced risk for invasive and expensive procedures.

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