BACK PAIN & PHYSICAL THERAPY By Vanessa Niemeyer, PT, DPT

Back pain is a topic regularly discussed by many people.  Most Americans will experience at least one episode of low back pain in their life.  Research suggests that 60 - 75% of those who experience one episode of low back pain will experience more episodes in the future and/or chronic low back pain.  Research also suggests that around 80% of individuals will experience at least 1 episode of low back pain in their lifetime.  According to the American Physical Therapy Association, roughly 25% of American adults report having had low back in the past 3 months.  

Back pain can be a result of many “problems,” such as degenerative disc disease, herniated discs, stenosis, scoliosis, pinched nerves and many more.  A thorough examination is required to assess what is producing your pain.   For some, there is a specific mechanism of injury, such as twisting at the spine while lifting a box crate.  For others, there is not a specific mechanism of injury, but rather the back pain is a result of the way we repeatedly perform activities, such as lifting items from the floor by bending at our waist (instead of our knees), sitting improperly for hours, or staying stooped over for prolonged periods of time and more.  

What does a Physical Therapy Examination/ Evaluation Involve?

When you first come in to your Physical Therapy clinic you will discuss specific details about your low back pain with your Physical Therapist, such as: what aggravates the pain, what alleviates the pain, is the pain constant, is the pain intermittent, when did the pain start, is the pain getting worse, better, or staying the same since the onset of your pain, and where exactly are your symptoms.  Based on your answers, other questions will be asked, such as: specifics about your job requirements (do you sit, stand, lift, push, pull, etc), specifics about your regular activities completed at home, and others based on you as an individual.  

After the questioning is complete, a physical examination will occur.  Spinal movement will be observed (to assess whether or not your movement is full and complete, or limited/ blocked in any direction).  Again, what occurs next is dependent upon how the beginning half of the examination goes.  Some of the following may occur: leg strength assessment, a sensory screen (to ensure that your nerves are functioning properly), and special tests such as straight leg raise, slump and a gait assessment.  These special tests are designed to help your Physical Therapist isolate your exact cause of pain. 

Every patient’s situation is unique  and different, so only the appropriate testing will be performed.  No two people walking in the door will have identical experiences during an evaluation.  

Here at Advanced Rehabilitation, we have three Physical Therapists that are currently certified in the McKenzie Method.  All of our other Physical Therapists are pursuing credentialization in the McKenzie Method.  

What is The McKenzie Method?

The McKenzie Method utilizes mechanical diagnosis and treatment (also known as repeated movements) to assess your symptomatic response to each repeated movement.  The primary goal of the McKenzie Method is to teach you as the patient how to independently treat your own back.  The McKenzie assessment is designed to look for significant pain reduction and significant improvements in spinal movement following repeated movements of the lumbar spine.  

If this sounds complicated, it isn’t.  Your Physical Therapist will teach you how to understand your signs and symptoms, understand what is “good,” and what is “bad” during the healing process.  The McKenzie Method emphasizes teaching you about your back, about your symptoms, how to resolve your pain, and how to prevent the pain from recurring.  

Statistics show that around 80% of patients with low back will respond to the McKenzie Method.  

What if I don’t respond to the McKenzie Method? 

It is critical to remember that every patient’s situation is unique and different, which is why not everyone gets the same cookie cutter exercise program.  All treatment interventions will be specific to you and your condition.  Of the patients who do not respond to the McKenzie Method, many still get better utilizing other treatment approaches.  

This is all dependent on what specifically is causing your pain.  The best way to determine whether or not physical therapy will be beneficial is to make an appointment.  Your Physical Therapist is trained to assess whether or not your symptoms are appropriate for Physical Therapy care or whether or not you would need to be referred elsewhere.  

Other treatment approaches emphasize strengthening and stretching the tissue that needs strengthening or lengthening.  Physical Therapists also have modalities to help reduce your pain such as mechanical lumbar traction, electrical stimulation, ultrasound, and cupping.  Physical Therapists are also trained in hands on techniques to help reduce low back pain, such as joint mobilizations, deep tissue massage, trigger point release, and manual stretching.  

What are some common causes of Low Back Pain?

1. Improper Posture:  When we slouch, we allow our back muscles to relax, and thus put all of the stress on our ligaments (that support the back of our spine).  We, essentially, hang on our ligaments.  If we slouch for long enough, we can cause permanent lengthening of those ligaments, which allow the tissue in our discs to move backwards.  Overtime, this can lead to the discs going farther and farther back, resulting in low back pain.  

2. Improper Lifting:  We are told time and time again to keep our back straight and avoid bending forward at our hips.  It is also important to avoid twisting at the spine; instead, twist by moving your legs and keeping your back straight.  When we are standing upright, we have our body weight and the force of gravity pushing down on our spine.  If we bend forward at our hips, we increase the amount of force going through our spine exponentially, thus increasing the risk of causing low back pain.  

3. Prolonged Forward Bending:  Many people will bend at their hips while they pull the weeds from their garden, vacuum, or clean a low surface.  It is important to stand up tall, give yourself frequent breaks, and bend at the knees when possible.  Staying in a stooped position for too long will, again, increase the stress on the ligaments in your spine, allowing disc material to move backwards (out of its optimal position).  

4. Prolonged Standing:  When we stand for prolonged periods, it is common for us to slouch, allow our muscles to relax, and thus, again, placing the stress on our spinal ligaments.  Move around, take breaks, and try to stay upright.  

5. Motor Vehicle Accidents:  This one is mostly out of our control.  If you are involved in a motor vehicle accident and experience back pain, seek medical attention.  Do not wait. 

How long should I wait prior to starting Physical Therapy? 

If your low back pain is unchanging over 72 hours, I would recommend not waiting.  If your pain is slowly getting better but is not resolving quickly, I would recommend not waiting. If your pain is getting worse over time, I would recommend seeking Physical Therapy care as soon as possible. The quicker you address your low back pain, the quicker you typically heal.  

Anatomy of the Low Back 

1. 5 vertebrae make up the lumbar spine (aka low back)

2. Intervertebral Discs are found between each vertebrae 

3. Spinal nerves exit at each level of the spine - exiting through openings known as the Intervertebral foramen (which simply means the opening between two vertebrae)

4. The spinal cord runs down through an opening known as the vertebral foramen

5. All of the spinal nerves branch off from the spinal cord

Final Thoughts: 

Your Physical Therapist is trained and ready to treat your low back pain.  Your Physical Therapist will educate you on your spinal anatomy at the level in which you desire.  You will be educated on appropriate and inappropriate symptoms that you should/ should not be feeling with activities at home and in the clinic.  Lastly, remember that here at Advanced Rehabilitation, we will create a treatment plan that is designed specifically for you.  

Please feel free to contact us with any questions/ concerns