Move Forward Guide
Physical Therapist's Guide to
Low Back Pain
If you have low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months. In most cases, low back pain is mild and disappears on its own. For some people, back pain can return or hang on, leading to a decrease in quality of life or even to disability.
If your low back pain is accompanied by the following symptoms, you should visit your local emergency department immediately:
- Loss of bowel or bladder control
- Numbness in the groin or inner thigh
These symptoms might indicate a condition called "cauda equina syndrome," in which nerves at the end of the spinal cord are being squeezed.
Signs and Symptoms
The symptoms of low back pain vary a great deal. Your pain might be dull, burning, or sharp. You might feel it at a single point or over a broad area. It might be accompanied by muscle spasms or stiffness. Sometimes, it might spread into one or both legs.
There are 3 different types of low back pain:
- Acute - pain lasting less than 3 months
- Recurrent – acute symptoms come back
- Chronic – pain lasting longer than 3 months
Most people who have an episode of acute pain will have at least one recurrence.
Often, low back pain occurs due to overuse, strain, or injury. It could be caused by too much bending, twisting, lifting—or even too much sitting. But just as often, the actual cause of low back pain isn't known, and symptoms usually resolve on their own.
Although low back pain is rarely serious or life threatening, there are several conditions that may contribute to low back pain, such as:
How Is It Diagnosed?
Your physical therapist will perform a thorough evaluation that includes:
- A review of your health history
- Questions about your specific symptoms
- Tests to identify any problems with posture, flexibility, muscle strength, joint mobility, and movement
- Tests to identify signs or symptoms that could indicate a serious health problem such as broken bones or cancer
- Assessment of how you use your body at work, at home, during sports, and at leisure
For most cases of low back pain, imaging tests such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are not helpful for diagnosing the cause. However, if your physical therapist suspects that your low back pain might be caused by a serious health condition, the therapist will refer you to other health care professionals for evaluation.
How Can a Physical Therapist Help?
Your physical therapist can help you improve or restore mobility and reduce low back pain—in many cases, without expensive surgery or the side effects of medications.
If you are having low back pain right now:
- Stay active, and do as much of your normal routine as possible (bed rest for longer than a day can actually slow down your recovery.)
- If your pain lasts more than a few days or gets worse, schedule an appointment to see your physical therapist.
Not all low back pain is the same, so your treatment should be tailored to for your specific symptoms and condition. Once the examination is complete, your physical therapist will evaluate the results, identify the factors that have contributed to your specific back problem, and design an individualized treatment plan for your specific back problem. Treatments may include:
- Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues
- Specific strengthening and flexibility exercises
- Education about how you can take better care of your back
- Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions
- Assistance in creating a safe and effective physical activity program to improve your overall health
- Use of ice or heat treatments or electrical stimulation to help relieve pain
Can this Injury or Condition be Prevented?
As experts in restoring and improving mobility and movement in people’s lives, physical therapists play an important role not only in treating persistent or recurrent low back pain, but also in preventing it and reducing your risk of having it come back.
Physical therapists can teach you how to use the following strategies to prevent back pain:
- Participate in regular strengthening and stretching exercises to keep your back, stomach, and leg muscles strong and flexible
- Keep your body in alignment, so that it can be more efficient when you move
- Keep good posture – don’t slouch!
- Use good body positioning at work, home, or during leisure activities.
- Keep the load close to your body during lifting
- Ask for help before lifting heavy objects
- Use an assistive device, such as a dolly or wheelbarrow, to transport heavy objects
- Maintain a regular physical fitness regimen—staying active can help to prevent injuries
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat people who have low back pain. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with low back pain.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.