Low Back Pain: Treatment Considerations

by Maureen Lefere, PT, ASTYM Certified

Low back pain, or LBP, is something most people will experience at some point in their lives.   In fact, 50% of working Americans will have back pain during their career.  It is the leading cause of disability in Americans under 45 years of age, it costs employers $7.4 BILLION dollars a year, and it is the third most expensive health condition in the US, second only to cancer and heart disease.  The costs in decreased quality of life, family disruption, depression, and general health are immeasurable.  If you are the person suffering from low back pain, the statistics don’t mean much, you just want a solution.    

There are many different approaches to treating low back pain and unfortunately,  no universal solution that works for everyone.  A research study performed in 1994 looked at 98 people with no complaints of LBP.  They completed MRIs on all individuals and found that 52% of these patients did in fact have positive disc bulges in their lumbar spines.  This demonstrates that a positive finding on an MRI, x-ray, or CT scan does not mean it will always be associated with pain.  In addition, several studies have shown the same statistical decrease in disability in individuals who underwent a lumbar fusion vs. those who received back care education and exercises.

So, how does one decide how to treat their low back pain?

Number one:  recognize that if this is your first injury, there is a very good chance that you will spontaneously recover without professional intervention.    We have a wonderful mechanism in our body called homeostasis where our body is always trying to restore itself to normalcy.    Often, just having this knowledge will decrease the stress response  which will often decrease the pain response without intervention.

Second, don’t stop moving.   The human body heals by moving white blood cells into damaged tissue, and then removing waste.   With immobilization comes stasis, or stagnation,  of fluid, swelling, muscle inhibition, and nerve irritation.    That does not mean continue doing activities that increase pain, but rest combined with graded, low intensity movement is best for promoting healing.   

Third, evaluate if you need a health care professional’s guidance.    When back pain is accompanied by leg symptoms such as numbness and burning, you should seek medical attention.    If back pain is accompanied by urinary frequency or loss of control of the bladder, you should go to the ER.    If back pain has not improved in one to two weeks with ice, rest, graded movement, and over the counter medication, you should see your health care professional.   

WHO TO SEE?   

There are many people who can help with your back.  Since I am a PT, I am going to share what we do.    This doesn’t mean there aren’t other professionals who can help you.    The questions that you should expect ANY provider to answer are:

1. What do they believe is the primary problem?
2. What will the provider do to address your problem?  
3. Approximately how long does the provider expect to see you?   This is sometimes a difficult question as back pain is complicated, but the provider should be able to give you a general idea.  

Physical therapists will conduct a thorough evaluation which will include looking at range of motion, strength, posture, neurological function, general tissue health, and endurance.     They will ask you about your pain, your past medical history, current medications, level of activity, sleep, work, and what your specific goals are. 

Therapists evaluate the entire system and may find areas of involvement away from your low back including your feet, hips, neck, or mid back.   Once the therapist has completed their examination, they will explain why you are having pain, their treatment plan, any precautions you may need to take to prevent re-injury, and will give you specific instructions for what you can do at home to manage your condition.    

This piece, to help you to self-manage your condition, is crucial to the long term success of your treatment.     Therapists empower patients with knowledge so that patients can treat themselves.    In this way, you are in charge of your health, and not dependent on a practioner or technique for pain relief.   

In the initial stages of therapy, when the primary goal is to decrease pain, therapists will use a variety of techniques, each specific to your condition.    These may include:

• manual therapy techniques, such as  joint mobilization/manipulation if you have a segment or segments that are not moving functionally or to promote fluid movement within a joint
• soft-tissue mobilization, to address muscle and fascia restrictions and to allow optimal muscle function
• nerve mobilization, to improve circulation and mobility in the nervous system itself
• microcurrent, to decrease inflammation and speed healing
• exercise, initially to improve circulation and facilitate endorphins and to prevent muscle atrophy and promote normal movement patterns.     

Exercise can also be used to restore range of movement (ROM) and to inhibit pain.  As your pain decreases, exercise becomes even more important as you re-build strength and endurance in the muscles that stabilize your spine and work on specific functional activities for your work and home life.    

Therapists at New Heights use primarily the STEP exercise concept which stands for Scientific Therapeutic Exercise Progressions.   This involves dosing your exercise regimen to the specific tissue that is injured as well as using appropriate resistance to the stage of recovery that you are in.     There is considerable evidence to support the STEP concepts and many times patients are surprised that they do not have a significant increase in soreness during or after exercise, in fact most often they have less pain.    

In addition to hands on treatment and exercise, your therapist will also communicate with other health care professionals on your team, make suggestions for additional resources (for example, nutritionists, chiropractors, acupuncturists, naturopaths, and physician specialists ) if needed, and communicate with your workman’s compensation representative if your injury occurred on the job.    

During your course of treatment, your therapists will be updating your home program and when you complete therapy you will have all the information you need to prevent re-injury and to maintain your low back health and function.    Your therapist will also provide their email information for future questions.    

A physical therapist’s primary purpose is to help your body return to the most optimal state possible and to restore the majority of your pre-injury function.   Our job is to make you not need us, and we are pretty good at it!!    A back injury or chronic low back pain does not need to be a lifelong condition, appropriate care and your commitment to your home program is the key to solving this common injury.   

Maureen “Mo” Lefere, PT , ASTYM Certified, works at New Heights Physical Therapy Plus, Vancouver Clinic