Physical Therapy for Back Pain

Physical therapy for back pain is one of the most common types of physical therapy.

Low back pain is the second leading cause of disability in the United States, accounting for >$50 billion in health care costs annually.

But that’s not what you’re thinking about when you can’t sleep due to that gnawing ache or you can’t bend forward without sharp pain.

I hope this page will help you understand more about the nature of your condition, what to expect, what you can do, and what not to do.

Contact us today if you are experiencing back pain or if you have any questions!

physical therapy for back pain baltimore

What’s causing my back pain?

This will likely be frustrating to read but, oftentimes we really don’t know. That’s why it’s called ‘non-specific low back pain.’ The back is a complex overlay of vertebral segments, ligaments, tendons, muscles, nerves & fascia – any combination of which can contribute to discomfort, aches, and pain. But don’t be discouraged, this in no way means that your back pain cannot be effectively treated.

Will imaging help figure out what’s causing my back pain?

It depends! For back pain that isn’t suggestive of “red flags” like severe trauma/fracture/infection or cancer-related pain (examples include: sudden incontinence, severe & sudden weakness, pain that doesn’t improve or worsen with movement) MRI imaging is oftentimes unnecessary. Even more, unwarranted imaging can actually lead to worse outcomes, higher medical bills for the patient, and lower rates of recovering from disability[1][2]. If, after 4-6 weeks of conservative care (such as physical therapy) you have made little to no improvement, imaging is often recommended at that time.

What is wrong with my back?

I do too! Unfortunately, it’s unlikely that imaging will tell you. We are the first generation of humans that have had access to MRI/CT technology and have been able to see inside a living person. Over the last few decades, this has caused the medical community (physical therapists included) to focus more on the structure that’s “wrong” or “broken” in the body rather than the person themselves. However, the structures we’ve been identifying as “broken” via MRI/CT (think labral tears of the hip/shoulder, or degenerative disc disease and disc bulges/herniations in the back) may not actually be the pain-generating abnormalities we thought them to be. It turns out that when we started putting pain-free people in MRIs/CTs, these “abnormal” structures are actually quite common with aging (think…wrinkles…but on the inside of your body) and can many times be present and completely asymptomatic, or pain-free.

Many imaging-based degenerative features are likely part of normal aging and unassociated with pain”
-Brinjikji et al

Take for example that 52% of 30-year old’s show disc degeneration, or that 60% of 50-year old’s show disc bulges and none of those individuals had pain [3] (and the list goes on.) While I  understand the desire to have imaging so that you can see what is going on with your back, the problem is that you are quite likely to find completely asymptomatic features on imaging and then attribute your pain to those “abnormalities” when in reality it’s possible they are unrelated to your presentation. Furthermore, when you read words on your report like “disc degeneration, disc herniation, arthritis, etc.” this can often times shift your mindset to seeing your back as weak, broken, fragile, or bad. This mindset can perpetuate beliefs such as “I can’t exercise (or, insert favorite activity here) anymore because I have a bad back.” The danger here is that exercise is often the best intervention for back pain (when done properly!) So, in summary, early imaging absent “red flags” will oftentimes lead to higher medical costs, no improvement in your outcomes, and the very real chance of leading you to believe your back is “bad” or “vulnerable” when it is in fact, anything but.

How can you fix my back when you don’t know what’s wrong with it?

As mentioned before, the medical community is beginning to shift away from its focus on structure-specific diagnoses/treatment and more towards treating the patient themselves. In essence,  there is no one-fix treatment. Back pain can result from a multitude of causes (for example, stiffness, hyper-mobility, prolonged sitting, weakness, poor coordination, over-use, under-use, etc.) Let me be very clear, anyone who is advertising X as the cure to back pain is trying to sell you something. Oftentimes, X may be helpful for some people with back pain (hence the testimonials) but exacerbate the pain of people who have back pain for other reasons. Therefore, it is essential that when struggling with back pain you see a provider that performs a thorough evaluation. Through a thorough evaluation, a provider (particularly a physical therapist) can rule out “red flags” and figure out the likely contributions to your pain as well as an effective treatment plan that is individualized to your presentation and, most importantly, your goals.

What can I do right now?

If you experienced major trauma or are noticing sudden and severe weakness or incontinence/paraesthesias in your groin area: go to the emergency room. Otherwise, give me a call and I can likely give you some advice over the phone based on your symptoms prior to getting you in for a visit. Generally speaking, the overwhelming majority of back pain cases are not the result of serious/significant trauma or damage and will improve gradually over the course of 4-6 weeks. However, there are certain things that will help your healing process and certain things that’ll make it worse.

Basic Guidelines to avoid back pain:

Don’t just watch Netflix.

            Bed rest for up to 1 day is okay if necessary, but any longer and you’re likely going to worsen your outcomes and prolong your recovery.

Move!

           This may mean you need to modify your activity/exercise for the short term, but move as much and as often as you can.

Pain is okay, to a point.

            If 0/10 is no pain and 10/10 is the worst pain imaginable (I know this scale is annoying) try and tolerate movement up to a 3-4/10 pain. If certain movements are causing sharp, 5+/10 pain, it doesn’t mean you have to stop moving altogether, it just means you’re not ready for those movements quite yet.

*Keep your spirits up.

            Back pain is extremely common. It doesn’t mean you’re weak, it doesn’t mean you’re fragile, it doesn’t mean you can’t get back to the activities you love. It just means that right now your back is irritated and it needs some work to get back to full capacity

[1] Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013;38(22):1939-1946. doi:10.1097/BRS.0b013e3182a42eb6

[2] Wáng YXJ, Wu AM, Ruiz Santiago F, Nogueira-Barbosa MH. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translat. 2018;15:21-34. Published 2018 Aug 27. doi:10.1016/j.jot.2018.07.009

[3] Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173