If you have low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months. In most cases, low back pain is mild and disappears on its own. For some people, back pain can return or hang on, leading to a decrease in quality of life or even to disability. Physical therapists help people with low back pain improve or restore mobility and reduce their pain.
Unfortunately, even though low back pain is common, treatment for low back pain often fails to reflect evidence-based guidelines, leading to over-treatment including unnecessary surgery or opioid prescription.
So what are the best approaches for back pain?
In March 2018, The Lancet noted that the guidelines are evolving: now there is “less emphasis on pharmacological and surgical treatments” and greater emphasis on “self-management, physical and psychological therapies, and some form of complementary medicine.”
If you experience back pain not related to an acute injury, here’s what you should consider:
The symptoms of low back pain vary a great deal. Your pain might be dull, burning, or sharp. You might feel it at a single point or over a broad area. It might be accompanied by muscle spasms or stiffness. Sometimes, it might spread into 1 or both legs.
There are 3 different types of low back pain:
Acute – pain lasting less than 3 months
Recurrent – acute symptoms come back
Chronic – pain lasting longer than 3 months
Most people who have an episode of acute pain will have at least 1 recurrence. While the actual cause of low back pain isn’t often known, symptoms usually resolve on their own. Psychosocial factors, such as self-confidence and a perceived ability to cope with disability, have been shown to be predictors of who might not recover from low back pain as expected. We used to believe the cause of low back pain was related directly to the tissues of our body, but are now understanding the condition to be more complex.
Although low back pain is rarely serious or life threatening, there are several conditions that may be related to your low back pain, such as:
Tumors of the spine
While we used to believe the above list contributed directly to low back pain, research has shown these conditions are also present in people without any pain (asymptomatic).
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, 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.
For most cases of low back pain imaging tests, such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are not helpful for recovery. For example, in a recently published article comparing 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 (with similar outcomes in each group). If your physical therapist suspects that your low back pain might be caused by a serious health condition, the therapist will refer you to other health care professionals for further evaluation.
Your physical therapist can help you improve or restore mobility and reduce low back pain—in many cases, without expensive surgery or the side effects of medications.
If you are having low back pain right now:
Stay active, and do as much of your normal routine as possible (bed rest for longer than a day can actually slow down your recovery.)
If your pain lasts more than a few days or gets worse, schedule an appointment to see your physical therapist.
Not all low back pain is the same, so your treatment should be tailored to for your specific symptoms and condition. Once the examination is complete, your physical therapist will evaluate the results, identify the factors that have contributed to your specific back problem, and design an individualized treatment plan for your specific back problem.
Treatments may include:
Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues
Specific strengthening and flexibility exercises
Education about how you can 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 electrical stimulation to help relieve pain