Physical Therapy Intervention for Lower Back Pain

Physical Therapy for Lower Back Pain

There are a variety of ailments that are treated with physical therapy methods and modalities, including lower back pain. In general, those who seek medical attention for lower back pain are usually referred by their physician to a physical therapist for about 4 weeks before involving more invasive procedures – such as surgery – to solve the problem. Physical therapists will use the modalities necessary to alleviate pain, increase function and mobility, and teach the patient how to maintain back health and minimize the chances of further increasing back pain.

Physical therapy for lower back can involve one or both of the following:

Passive physical therapy – where modalities and other methods are used on the patient while they relax and allow the therapist to do all the movements on the patient;
Active physical therapy – where the patient uses his or her own force to apply therapeutic measures, such as actively exercising or stretching.

The majority of physical therapists focus on active physical therapy to alleviate lower back pain, and eliminate the cause of the pain and discomfort.

Exercise During Physical Therapy for Lower Back Pain

The idea behind exercising to treat lower back pain issues is to help stabilize the core and take some of the pressure off the muscles in the lower back. Lower back stability depends a lot on the supporting abdominal muscles and lower back muscles. The abdominal muscles provide the spine with support in the front of the torso, while the lower back muscles support the spine from the back. By strengthening and developing the muscles in these specific areas, a great deal of stress can be taken off the discs and joints of the spine, therefore alleviating lower back pain.

This is why exercise and stretching play a vital role in helping to reduce pain and discomfort felt in the lower back region. A regular exercise routine can help to improve and increase mobility and function, as well as decrease the chances of another episode of severe lower back pain.

The following types of exercises are common in physical therapy clinics to help treat lower back pain in patients:

Stretching – Adequate stretching before, during and after an exercise routine can help alleviate pain in the lower back by improving range of motion, relieving muscles that are not used enough, and reducing muscles spasms caused by improper posture and irritated nerves. A physical therapist will assign specific stretches for each patient to tailor the program specifically for each individual. In general, stretching muscles of the lower back, abdominals, hips and legs are usually recommended.

Strengthening of the Core Muscles – Physical therapists will usually encourage strengthening the muscles of the core, including the abdominals and lower back muscles. Doing this will strengthen the ‘belt of muscles’ around the body, which will help to stabilize the spine and relieve pressure and tension on the discs. Common exercises for this purpose usually include the following:

  • Abdominal crunches
  • Leg raises
  • Lower back raises
  • ‘Good mornings’ (lowering stomach/back until parallel with the ground, keeping the legs straight, then raising back up to starting position)

Any type of exercise that strengthens the muscles of the core will be beneficial.

Dynamic Stabilization Exercises – These types of exercise routines helps to strengthen the secondary muscles in the spine, and help to support the spine. This type of exercise typically involves the use of equipment such as exercise balls or stabilizing machines, as well as simply performing specific stabilization exercises.

Hydrotherapy for Lower Back Pain

There are many physical therapy clinics that offer hydrotherapy to help alleviate lower back pain. This involves the use of warm, pulsating water in a whirlpool or hot tub to help relieve tension and discomfort in the lower back. The effect of this warm water helps to lift the weight off the lower back, therefore providing some relief. Engaging in hydrotherapy can also loosen the muscles enough to get them prepared for an exercise routine.

Lumbar Traction for Lower Back Pain

Many physical therapists will also make use of lumbar traction to help deal with a patient’s lower back pain. Traction involves the use of a machine that unloads the disc space and muscles in the lower back area, which helps to relieve pressure off the muscles and discs. This method involves having the patient lay down on their back on a special table, and fastening them to a strap that is placed around the patient’s hips. This cable is then attached at the foot of the table, which gradually pulls down on the cable to create this disc space.

Conclusion

Physical therapy methods and modalities can be highly effective in treating lower back pain and discomfort in patients. Physical therapists will tailor a specific program for each patient in order for them to reap as many benefits as possible to a physical therapy program. It is extremely important that the patient continues and maintains the exercise and stretching program at home prescribed by their physical therapist in order for the patient to maintain the lower back pain alleviation, and prevent any future episodes of pain and discomfort in the lumbar region.

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Commonly Treated Injuries With Physical Therapy

The Many Uses of Physical Therapy

Physical therapy is a clinical practice that has its uses with a variety of physical ailments. Physical therapists work in a variety of settings, from hospitals, to clinics, to home settings. Many different ailments are alleviated with the use of physical therapy practices, including fractures, injuries from car accidents, strokes, heart attacks, arthritis and even Alzheimer’s disease. The following is a comprehensive list of the most common types of injuries and ailments that are treated with physical therapy treatments and modalities:

Arthritis

Arthritis is a common ailment that many patients suffer from, particularly as people age. This disease can be classified into 2 categories:

Osteoarthritis – This degenerative joint disease is chronic and progressive, and has a tendency to cause bone spurs at the joints. After the cartilage within the joints starts to wear down because of this disease, great discomfort is felt at the joint, which also causes limited movement and muscle weakness.

Rheumatoid Arthritis – This is a connective tissue disease that varies in its onset and flare-ups from person to person. These flare-ups cause the cartilage to erode, causing significant pain in the joints.

Physical therapy helps to alleviate the discomfort felt with arthritis by using a variety of treatment methods, including:

  • Posture and mechanics training
  • Joint protection principles
  • Energy conservation techniques
  • Supportive/Corrective devices
  • Pain management
  • Stretching and strengthening techniques

The type of treatment used will depend on whether the patient is in a flare-up or remission stage.

Bursitis

Bursitis occurs when the bursas in the joints become inflamed due to excessive motion or strain at the joint site. These bursas cushion the muscles, bones, ligaments and tendons within the joint – if they become inflamed, this can cause considerable pain and/or discomfort. The most common areas for bursitis to occur include the hips, shoulders, buttocks and groin.

Physical therapy for bursitis can come in many forms, including:

  • Ultrasound
  • Educating the patient on body mechanics and the movements that provoke symptoms
  • Stretching and strengthening the muscles
  • Correcting imbalances between opposing muscle groups
  • Pain management methods

Hip Pain

There are many reasons why a person may be experiencing hip pain, including the following:

  • Osteoarthritis
  • Sciatica nerve impingement
  • Bursitis
  • Uneven leg length
  • Dislocations
  • Sacro-iliac joint dysfunction
  • Poor posture
  • Obesity
  • Stress fractures
  • Muscle imbalances

After the cause of the hip pain has been determined, a number of different physical therapy methods and modalities may be used to cure the condition or alleviate the symptoms. Such physical therapy methods for hip pain may include:

  • Ultrasound
  • Electrical stimulation
  • Stretching and/or strengthening muscles
  • Educating the patient about proper posture and body mechanics
  • Pain management methods

Knee Pain

As with hip pain, the source or cause of the knee pain needs to be established before any physical therapy intervention can occur. Many times knee pain is caused by injuries which cause tearing of the ACL – or anterior cruciate ligament – which is a common occurrence among athletes. This type of injury generally requires surgery to repair the torn ligament. Following surgery, physical therapists will usually get involved to help accelerate the healing process and minimize pain and scar tissue development in the area. With this injury, many physical therapists will usually integrate aggressive strengthening and range of motion protocols to deal with the knee pain following surgery from a torn ACL.

Other common reasons for knee pain may include:

  • Arthritis
  • Meniscal tears
  • Patello-femoral syndrome

Lower Back Pain

Physical therapy clinics often see patients who are looking to be treated for lower back pain. After assessing the patient for any serious underlying issues, the physical therapist will then determine the best method of alleviating this lower back pain. This discomfort may be caused by any of the following:

  • Lumbar sprain
  • Disc bulge
  • Hernias
  • Sciatica

Many of the more common treatment methods used in physical therapy to deal with lower back pain may include the following:

  • Soft tissue mobilization
  • Rehabilitative exercises
  • Educating patients on proper posture and mechanics
  • Flexibility and strengthening of the muscles
  • Ice or heat
  • Ultrasound
  • Electrical stimulation

Neck Pain

Many patients with neck pain often go in to see a physical therapist to alleviate pain and discomfort. This pain is often caused by a car accident, poor sleep postures, and even repetitive motions. Physical therapy for neck pain often involves:

  • Reducing inflammation
  • Strengthening the muscles around the neck
  • Improving posture

Shoulder Pain and Discomfort

Physical therapy is often engaged in to relieve painful symptoms related to a number of shoulder injuries, such as rotator cuff injury, tears in the ligaments or tendons, or Impingement Syndrome. The physical therapist may involve the following methods for dealing with shoulder pain, including:

  • Strengthening the muscles and ligaments in the affected area
  • Inflammation control
  • Soft tissue mobilization

Many times these treatment methods are sufficient to solve the problem. In more severe cases, physical therapy can be combined with more invasive treatments, like surgery, to fully deal with the condition.

Sports Injuries

Sports injuries are very common among athletes. When an athlete has injured a part of their body, physical therapists will employ any number of treatments and methods to heal the affected area and get the athlete safely back into competition. Many sports therapists will use the following treatment methods for sporting injuries:

  • Ultrasound
  • Electrical stimulation
  • Exercise training
  • Chiropractic adjustments

Conclusion

Physical therapy is often an essential part of the healing process following acute injury or chronic conditions and diseases. It can help to alleviate pain, as well as significantly reduce any scar tissue build up. Engaging in physical therapy treatments can help patients with many conditions regain their mobile independence and significantly reduce discomfort.

Physical Therapy After a Bone Fracture

Bone fractures of all sorts happen all the time, and are commonly seen by physical therapists every day. Whether the fracture occurs in the femur, ankle, pelvis, clavicle or any other location on the body, immediate medical attention is required. The bone will need to be properly aligned, healed and set by a medical doctor. It will also need to be reduced, either manually or through a surgical procedure if the fracture is quite severe. Surgery may be recommended and required if the bone was shattered into multiple pieces, requiring it to be put back together in the correct place through an open reduction internal fixation surgical procedure.

A cast will often need to be worn for a few weeks, whether in the form of a hard cast or a removable cast. Once the proper healing has taken place, physicians will often refer patients who have fractured a bone to a physical therapist to help accelerate the healing process, reduce pain and swelling, and improve range of motion to get the patient back to their normal physical self.

Beginning Physical Therapy After a Bone Fracture

Physical therapy is most often incorporated into a bone fracture patient’s healing routine after sufficient healing has taken place, and the bone is properly aligned. Physical therapy will help to strengthen the bone and the muscle tissue surrounding the bone in order to help the patient regain full range of motion and independent mobility and function. After enduring a bone fracture, a patient may encounter physical therapy at various stages, depending on what their physician feels will optimize full recovery.

At the Hospital – Physical therapy can begin as early as within a hospital setting, particularly if the bone fracture was quite severe and required some form of surgery for proper repair and alignment of the bone. Physical therapists may visit these patients in the hospital, and teach the patient how to move properly while rehabilitating the injured area.

If the bone fracture occurred anywhere in the ankle, leg, knee or hip area, the physical therapist will instruct the patient how to walk properly and efficiently to help regain full range of motion, as well as how to walk with an assistive device like crutches. Simple actions, like getting in and out of a car or going up and down stairs can prove to be challenging when walking with an assitive device. Therapists will teach these patients how to perform these motions effectively while healing.

At Home – After a bone fracture patient is well enough to leave the hospital setting, physical therapy will continue in the patient’s home if they are still too immobile to leave their home to travel to a physical therapy clinic. A physical therapist will continue to assist the patient with moving around the home efficiently while using their cane, crutches, arm sling, or any other assistive device.

The therapist will also engage in a number of treatments that are comfortable for use within the home, such as joint mobilization, massage or exercise. Exercise routines will be one of the first things a physical therapist will most likely get the patient started on. Specific exercises will be assigned to the patient to help them strengthen their muscles and joints, as well as slowly improve and increase their range of motion. Weight bearing exercises can be particularly helpful to help strengthen the injured area.

The physical therapist may also assess the home environment, and ensure that there are no potential hazards while the patient regains full mobility.

In the Clinic – Patients who have had a cast or sling removed and are physically capable of going outside the home are often referred to a physical therapist by their physician to continue rehabilitating the injured site. This is important in helping the patient regain full function following a bone fracture and any surgery or other treatment to heal the fractured bones and surrounding tissue.

The patient may still be required to avoid certain weight lifting that they may have been able to do prior to the fracture – it’s important for the patient to adhere to any restrictions that their physical therapist has placed on them in order to avoid any further damage to the injured area.

In the clinical setting, the physical therapist will assess and take measurements of a variety of factors, including the following:

  • Range of motion
  • Strength
  • Function
  • Pain
  • Flexibility
  • Swelling
  • Gait in lower extremity bone fractures

After an initial assessment and evaluation, the physical therapist will set out a treatment plan to help the patient fully recover. This treatment plan may vary in length, depending on a number of factors, including the severity of the bone fracture. Part of the therapy will involve helping the patient get over any negative effects that come with having a limb or other body part in a cast or sling, such as muscle atrophy or decrease in mobility.

The physical therapist may use a variety of modalities to help rehabilitate the injured area, such as ultrasound, TENS, hydrotherapy or electrical stimulation. Massage and mobilization may be used when scar tissue has developed. Exercise will almost always be employed when the patient is physically capable of applying pressure to the affected area. Exercise will help to develop the muscles and improve strength and mobility in and around the affected area.

Conclusion

Physical therapy is often an essential step after initial healing and assessments have been made on an injury. Physical therapy treatments and modalities can help to accelerate the healing process, and improve strength and mobility after a patient has suffered a bone fracture. It is important to perform all the actions that physical therapists recommend, both within a clinical setting and at home.

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Treatments and Modalities Used in Physical Therapy

Many patients who have gone through an accident, sports injury, or other physical disability due to other acute incidents or chronic diseases may be referred to a physical therapist from their health care physician. Physical therapy can help in a number of areas, and can help a patient to gain mobility and functional independence, as well as decrease pain. Some ailments have only a minor effect on a patient’s mobility, while others can severely inhibit a patient’s mobility and range of motion.

There are variety of ways in which a physical therapist will treat a patient, depending on the exact ailment, and the degree of pain that the patient is suffering. The goal when selecting a treatment method or modality is to reduce pain and inflammation, accelerate the healing process after an injury, strengthen the muscles, and increase range of motion. The following is a list of treatment methods and modalities used by a physical therapist to treat patients with a number of physical issues.

Exercise

Exercise is a very common and non-invasive method of treatment used in a physical therapy setting. Exercise can help to improve a patient’s strength, flexibility and range of motion, and can help a patient regain their functional and mobile independence. Exercise therapy can be classified as either passive or active.

Active exercise therapy involves movements that are done within the patient’s own power and ability. This includes leg raises, jumping on a trampoline, walking on a treadmill or performing lateral arm raises. All these examples are exercises performed with the patient using their own power to move.

Passive exercise therapy involves the physical therapist applying the stress on the patient’s muscles or joints, while the patient relaxes. An example of a passive exercise routine is one where a patient lies down, and the physical therapist lifts the straight leg in order to help elongate the hamstring muscle.

Exercise is almost always incorporated into a physical therapy program, and is usually involved in activities that the patient will be instructed to perform at home on their own, in addition to the clinical setting with a therapist.

Ultrasound

Many different musculoskeletal conditions, such as muscles strains and tendonitis, are treated with ultrasound by a physical therapist. This type of therapy involves the use of deep heat using an ultrasound machine and a wand that is gently pressed against the skin over the affected area. This wand is then moved in small circular motions over the injured spot in an effort to have ultrasound waves absorbed into the skin and muscles with the help of a small amount of gel.

Traction

Traction is particularly helpful for those who suffer from lower back pain and neck pain, especially after a car accident. This type of physical therapy helps to decrease this pain and increase the spine’s mobility by separating the joints and disc spaces in the lower back and/or neck, alleviating pressure on spinal nerves.

Lumbar traction involves the patient being strapped into a traction machine with a vest to support the ribs and a belt that wraps around the patient’s pelvic region. After the vest and belt are secured and stabilized, force is applied with a machine.

Cervical traction involves a harness being attached to the patient’s head, as well as a pulley system and small weight. As the patient sits or lies comfortably, the weight will provide some traction force, and alleviates pressure on the cervical area of the neck.

Electrical Stimulation and TENS

Electrical Stimulation and TENS is used by physical therapists to help alleviate pain at the injured site. TENS – or transcutaneous electrical neuromuscular stimulation – sends electrical signals to the injured muscle or tendons to help stimulate reaction and development. Electrical stimulation may also be used to contract the muscles to help them learn how to function efficiently after injury. This is referred to as “neuromuscular electrical stimulation” or NMES.

Light Therapy

This type of treatment is used by physical therapists to help accelerate the healing process at an injured site. Light therapy uses light at a specific wavelength, and involves the therapist holding a light emitting wand over the injured area. This treatment is painless, and only takes a few short minutes to administer.

Joint Mobilization

Joint mobilization involves a physical therapist applying passive pressure to a patient’s joints to help improve mobility and range of motion within the joints. Although joints move in a hinge motion many times, they also have gliding motion capabilities as well. The therapist will apply pressure to glide these joints in order to decrease pain and improve mobility.

Massage

This is quite a common physical therapy technique that involves the therapist applying pressure to the affected area to help decrease pain, reduce muscle tension and improve circulation.

Heat and/or Ice

These are common treatments used by physical therapists to help reduce pain and swelling, improve circulation and relax the muscles.

Hydrotherapy

Physical therapists will sometimes have their patients sit in a whirlpool to reap the benefits of hydrotherapy. The heat and motion of the water in the whirlpool can help to control inflammation, improve circulation, sooth wounds, relax muscles and improve range of motion.

Conclusion

Physical therapy involves the application of a variety of types of treatment and modalities to help effectively treat a patient. Depending on the type of injury or disease suffered, and the degree of pain and swelling, a physical therapist will choose the appropriate modality to use that will have the most helpful effect on the patient.

What is Physical Therapy, and What Do Physical Therapists Do?

What is Physical Therapy?

Physical therapy is a rehabilitative specialty that helps to improve a person’s physical and functional abilities. It includes evaluating and assessing a patient’s physical limitations, and treats these issues with proper and targeted treatment methods to improve functional mobility. Patients who may be physically hindered by aging, sporting hazards, accidents, disease and other acute injuries can benefit from physical therapy. Treatment services within the physical therapy realm are administered by highly skilled and educated physical therapists who are licensed within the state that they are employed.

The field of physical therapy also handles the promotion of overall health, and prevention of injury and physical disabilities. Rather than engaging in medical or radiological measures, physical therapy offers a clinical alternative to rehabilitate a variety of ailments.

Who Needs Physical Therapy?

There are a variety of reasons why a person would seek treatment with a physical therapist. Any injury, disease, illness or age-related ailment can be treated with physical therapy sessions. Many physical impairments or loss of function issues can be helped with the assistance of a physical therapist.

The following is a list of the five most common areas of specialty with physical therapy:

Orthopedic Physical Therapy

This field of physical therapy involves treating patients who have had some sort of musculoskeltal disorder or injury. This can include post-operative rehabilitation, treatments following car accidents or anything related to a sports injury. Within this orthopedic physical therapy realm, the following are
areas that are treated by a physical therapist:

  • Arthritis
  • Sports injuries
  • Post operative joints and musculoskeletal injuries
  • Amputations
  • Diseases affecting the bones, muscles, tendons and ligaments

Neurological Physical Therapy

Physical therapists who specialize in the field of neurological physical therapy treat patients who have some type of neurological disorder. The following is a list of diseases and disorders affecting the neurological system that specialized physical therapists treat:

  • Stroke
  • Paralysis
  • Multiple Sclerosis
  • Alzheimer’s disease
  • Spinal cord injuries
  • Parkinson’s disease
  • Cerebral palsy
  • Vision problems
  • Balance problems
  • Walking impairments

Geriatric Physical Therapy

Patients who are elderly and suffer from age-related diseases and disorders can be treated by a physical therapist who specializes in geriatric physical therapy. The following is a list of ailments that are treated within this realm:

  • Alzheimer’s disease
  • Joint replacement
  • Hip replacement
  • Arthritis
  • Osteoporosis
  • Incontinence
  • Balance problems

The physical therapist who specializes in this field will help the older patient regain some mobility, manage pain, and optimize fitness levels.

Cardiovascular/Pulmonary Rehabilitation Physical Therapy

Patients who suffer from any disorder or disease of the heart, cardiovascular, circulatory or pulmonary system can be treated by a physical therapist who specializes in the field of cardiovascular/pulmonary rehabilitation physical therapy. The goal in this realm of physical therapy is to help patients improve
their endurance and physical mobility. The following are some of the conditions that are commonly treated by physical therapists within this specialized field:

  • Patients who have had a heart attack
  • Patients who suffer from pulmonary fibrosis
  • Patients who have had bypass surgery
  • Patients who suffer from COPD

Pediatric Physical Therapy

There are various pediatric disorders that can be treated with the help of a physical therapist. Some of these disorders include the following:

  • Spina bifida
  • Cerebral palsy

Any type of condition that severely limits the mobility and functional movement of a particular body part may be treated with great success through physical therapy treatments.

What to Expect During a Physical Therapy Treatment Session

The type of treatment method used by the physical therapist depends on a number of factors, including the type of ailment or disorder affecting the patient, as well as their age and overall physical health. Many different techniques are used to treat patients, including the following:

  • Exercise
  • Ultrasound
  • Electrical Stimulation and TENS
  • Traction
  • Joint Mobilization
  • Massage
  • Heat Ice
  • Laser or Light Therapy
  • Whirlpool

The goal of physical therapy treatment is to improve a patient’s range of motion, decrease pain and stiffness, increase strength and improve independent mobility. Physical therapists will also educate the patient on the condition they face, and help the patient to understand their exact diagnosis and treatment options.

Where Physical Therapy Takes Place

Physical therapy can take place in a number of settings, including hospitals, sport therapy clinics and doctor’s offices. There are also physical therapists who visit patient’s homes for those who are severely physically disabled. Physical therapists will also visit daycares, schools, nursing homes, long-term care facilities and office settings to make therapeutic sessions more accessible for those who need to be in more familiar and comfortable settings.

Conclusion

Physical therapy can help a variety of patients with many different conditions and ailments overcome their functional disabilities. Many times this type of clinical practice can be a great alternative to more invasive treatment like surgery. Seeking out a specialized physical therapist to target a specific ailment can be highly therapeutic, and can relieve much pain, discomfort and immobility.

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