Physical Therapy for Low Back Pain
By Brett Sears, About.com Guide
Low back pain is the most common diagnosis seen in many physical therapy clinics, and it
affects nearly 85-90% of Americans at one time or another. It is the second leading cause
of visits to a doctor, after the common cold. Low back pain is also the leading cause of lost
time at work, and billions of dollars are spent each year diagnosing and treating low back
What Exactly Is the Low Back
The low back, or lumbar spine, consists of five bones, or vertebrae, stacked upon one
another. Between the bones are soft, spongy shock absorbers called intervertebral discs.
The spinal cord and nerves are protected by these bones. Multiple ligaments and muscular
attachments provide stability and mobility to the lumbar spine.
What Causes Low Back Pain
The three most common causes of low back pain are poor sitting posture, frequent forward
bending, and lifting heavy items.
Although trauma may be a cause of low back pain, most often there is no apparent reason
for the onset of symptoms. Thus, it is thought that repetitive strain on the structures around
the lumbar spine is the main cause of low back pain.
When to Seek Help
Remember, low back pain can be a serious problem and it is highly recommended to
consult a physician, physical therapist or other qualified health care provider if low back
symptoms are present and are significantly limiting function and mobility. Also, there are a
few signs and symptoms that require immediate medical attention. Theseinclude, but are
1. Loss of muscular control. If sudden loss of muscular control in the hip, thigh, calf,
shin, or toes occurs, an immediate referral to a physician is warranted. If you are not
able to lift your leg to walk, rise from a chair, or walk up stairs, you may have a serious
problem that needs medical attention.
2. Loss of bowel or bladder function. If structures in the low back are compressing the
spinal cord or nerves that control bowel and bladder function, loss of bowel or bladder
control may occur. Most often, the primary symptom is inability to urinate. If this
occurs with onset of low back pain, it should be considered a medical emergency and
immediate medical attention is required.
3. History of cancer or metastatic disease. Although rare, it is always a good idea to
see a physician if you have a recent onset of low back pain and a history of cancer.
Simple tests can be performed to rule out metastatic disease and proper treatment
can be initiated.
4. Recent significant trauma. Although rare, low back pain can be brought on by
trauma such as falls or motor vehicle accidents. If significant trauma has taken place
and caused acute low back pain, a visit to a physician to rule out a fracture is required
before initiating treatment.
Where is Low Back Pain Felt
Symptom location may also be helpful to identify the cause of the problem and to start self-
management of low back pain. The most common symptoms coming from the lumbar
spine can be found here.
What to do When Low Back Pain Occurs
If you are currently experiencing low back pain, one or two days of rest is indicated. After
this short time period, gentle self-care exercises should be started to restore mobility and
decrease pain. Since poor posture is a major cause of low back pain,maintaining proper
posture is important. Use a small pillow or towel roll to support the spine while sitting.
Remember, if pain prevents you from exercising or if pain persists for more than 2-3
weeks, a visit to a physician, physical therapist, or other health care provider is necessary.
What to Expect from Physical Therapy
When low back pain is persistent or interferes with normal activities, a visit to a physical
therapist may be necessary. When you go to a physical therapist, he or she will perform an
initial evaluation on the first visit. Be prepared to move around quite a bit, so be sure to
wear comfortable clothing and make sure that your low back is accessible.
An initial evaluation will consist of several different parts. First, a history about your present
problem will be taken. Be prepared to discuss your symptoms and what activities or
positions make your symptoms better or worse. Some special questions will be asked to
help the therapist determine the nature of your problem and to discover anything that
needs immediate medical attention.
The physical therapist will also take measurements of how you are moving. This may
include measurements of your range of motion and strength. A postural assessment will
also be included in the initial evaluation. From the results of the evaluation, a specific
treatment plan will be devised and started. It is important to remember to be an active
participant in your treatment and ask questions if you are unsure of what to do.
When an acute episode of low back pain strikes, don't panic. Most studies indicate that
acute low back pain is short lived and most symptoms resolve spontaneously in a few
short weeks. With that in mind, low back pain, although short lived, tends to be episodic in
nature. Many times, people have multiple episodes of low back pain during their lifetimes.
Recurrent episodes tend to get progressively worse with the passage of time. Therefore, it
is important to not only treat the symptoms of low back pain, but also to have a strategy to
prevent future low back problems.
One of the most important times to care for your low back is when you have no symptoms.
By maintaining proper posture and appropriate strength and mobility in the spine, episodes
of low back pain may be avoided completely.