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Back Pain Treatment: Physical Therapy

Physical Therapy

Physical therapy uses different techniques, such as ultrasound, electrical stimulation, cryotherapy, massage, exercise, and heat in order to relieve muscle spasms, increase flexibility, strengthen muscles, relieve pain, and accelerate the healing process. A study in The New England Journal of Medicine found that the effectiveness of physical therapy for lower back pain was about the same as that of chiropractic treatment and better than no treatment at all.

Physical therapists must graduate from an accredited physical therapy program, many of which offer master’s and doctoral degrees along with bachelor’s degrees. Most schools require two to four years of pre-physical therapy coursework before admittance. Like other physical treatment programs, physical therapists spend time in both the classroom and medical settings before graduation. After graduation, they must take exams to become licensed, and some states require continuing education to maintain that license.

After it is determined by a doctor or back specialist that you are a candidate for physical therapy—some time between two to six weeks after the onset of lower back pain or sooner if the pain is severe or recurs frequently—you will meet with the therapist to determine the best plan of treatment for you. You will be asked how your back pain developed, how long you’ve had it, whether or not it’s recurring, what actions make the pain better or worse, and any relevant medical history you have. The therapist will also give you a physical exam of your spine movement, muscular flexibility, sitting and standing posture, muscle strength, reflexes, respiration, motor function, and repetitive movements. From there, he or she will determine which treatments will be best for you. There is some trial and error involved, so if one treatment doesn’t work to alleviate pain, the physical therapist may try something different.

There are basically two types of physical therapy, passive and active. Passive therapy is done to you and includes heat, cryotherapy, electrical stimulation, ultrasound, massage, and lontophoresis. In heat, or thermal, therapy, the therapist applies heating pads, heat wraps, or warm gel packs to the affected area. This works to increase the flow of oxygen to the muscle, allowing it to heal faster and relieve pain by softening muscles. In cryotherapy, cold is applied rather than heat, and is considered more effective than heat in reducing inflammation. Electrical stimulation sends mild electrical impulses to the nerves and spinal cord, which releases endorphins and blocks pain signals from the brain. Ultrasound heats the deep tissue and allows it to relax and stretch more easily. Massage breaks up scar tissue and encourages the relaxation of muscle spasms. During lontophoresis treatment, a painkiller and steroid are rubbed into the skin and a low level electrical current is applied to speed up the absorption of the drugs. It works similarly to transdermal patches used to quit smoking.

You participate in active therapy, and it includes stretching, strength building exercises, and aerobic exercise. A good physical therapist will combine passive and active treatments, as exercise is essential to treating back pain. The therapist will determine which exercises are best for your particular condition and supervise you in those exercises to ensure you are doing them correctly. You will likely be given stretches to be done daily, fifteen to twenty minutes of strengthening exercises, and thirty to forty minutes of low-impact aerobic exercise, such as swimming or walking, to be done three times a week.

You may feel some soreness or discomfort after active physical therapy, but it should go away in about twelve to eighteen hours. If it doesn’t, let your therapist know. You may need to change exercises or how you are exercising. Results vary depending upon the type of treatment done and the severity of symptoms, but a physical therapist should know in about two weeks if the treatment is working or not.

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