How do we approach low back pain?

Back pain is a very common complaint: Like a cold, it often resolves on it’s own in a few weeks. When it notably limits your life, is severe or persistent, PT can help speed recovery and address underlying factors to reduce future occurrences.

Treating low back pain begins with a thorough history: Once the specific area of pain is identified and it’s intensity, chronicity, sensitivity, and provoking factors are clarified, an individualized plan can be developed.

Treatment approach depends on symptom severity:

• High irritability: If your pain is severe, easily provoked, and lingers at a high level, you are likely having a chemical or inflammatory response within the body. During this phase of injury, your therapist will prescribe active rest and encourage movements that do not overly stress your healing tissues.

  Taping, bracing, or postural training may be utilized to protect and promote healing.  Exercise will likely be focused on activation and motor control, and may be limited to a specific tolerated plane and range of motion. In general, the spine loves light gentle movement like walking!

• Low irritability: If you have a lower severity of pain and non-lingering symptoms, your symptoms are likely more mechanical. In this instance, therapy can be more aggressive. Exercise will help restore strength, endurance, complex motor control, and be tailored to your specific needs.

Treatment approach also depends on your specific presentation and may include:

• Coordination & Strength: The spine is structurally strong, and incredibly resilient when the muscles of the trunk can perform adequately for the tasks we face in daily life and fitness activities. A lack of coordination, strength, and endurance can drive low back pain. Pain can also inhibit the muscles of the trunk from doing their job. Graded motor control or coordination exercises, in addition to strength and endurance training can address deficits in this realm and improve your capacity.

• Repeated specific movements (McKenzie): Some symptoms respond to repeated movements in particular directions. There will often be a direction which alleviates symptoms and a direction which provokes symptoms. Appropriate dosing and frequency for your body is key and your physical therapy can provide guidance. Once symptoms settle, we can restore comfort and ease in the range that was previously provocative.

• Mobility training: Stiffness in the joints, muscles and fascia of the spine can cause pain. Compensatory movement above or below a region of stiffness can also become painful. Mobility of the ankles, hips,  SI joints, and mid back can also influence how the low back feels and moves.  Hands-on work, myofascial decompression and therapeutic exercises can improve mobility.

• Traction:  If you have pain that radiates into your leg (symptoms like sciatica), spinal decompression can provide relief.  At True North Physical Therapy, we encourage active traction that allows independence with symptom management at home (as opposed to being left on a traction machine).  Your therapist will give you specific postures and exercises that help decompress a sensitive spine.

• Other factors: Breathing patterns, as well as stress and GI issues, and pelvic floor dysfunction can also play a role in low back pain. Your physical therapist will screen for these factors and address them if relevant.

Do I need to see a physician? While imaging may inform treatment, it is primarily used to guide interventions, such as injections. Imaging is not needed to start physical therapy.

Imaging is also used to rule out major red flags if there are suspected, such as a spinal tumor. Your physical therapist is trained in screening for red flags and will refer you for further workup as appropriate.