SpineUniverse.com states that 80 percent of the population will experience an episode of low-back pain during their lifetimes. Most patients do not know what causes their back pain. Usually it can be determined that pain is caused by poor posture and the position of the body during certain activities, not the activity itself. The American Physical Therapy Association states that physical therapists can help patients reduce pain and improve mobility without surgery or medications.
Passive Modalities
"The New York Times" published a report about the role of physical therapy and back pain. According to the "Times," the first stage of therapy involves patient education. Spinehealth.com also states that when pain is acute, therapy should be passive, or therapies done to the patient, not by the patient. Passive therapies include heat and ice packs; transcutaneous electrical nerve stimulation, or TENS, units; and ultrasound. The "Times" states that exercise does not help acute back pain. The acute phase of back pain is considered to take place during the first two to eight weeks after the onset of pain.
Heat Therapy
Superficial heat packs heat the back muscles at a depth of 1cm to 2cm, notes Spine Universe. This type of heat is beneficial for diminishing pain and decreasing muscle spasms. During the acute phase of back pain, heat is used primarily for reducing pain and inflammation. Ultrasound is a deep-heating modality that is effective for heating deeper tissues. It helps relax connective tissues, which facilitates stretching. It is best used for chronic low-back pain, because in the acute phase it may exacerbate the inflammatory response.
Cryotherapy
Cryotherapy, or the use of ice packs, is more effective than heat in penetrating deeper into the muscles. The reduction in muscle temperature helps to reduce the metabolism, which reduces inflammation and pain, according to Spine Universe. Ice acts as an analgesic, decreases nerve conduction along pain fibers and reduces the muscle spindle activity responsible for maintaining muscle tone. It is usually most effective during the acute phase of pain, although a patient may use it for chronic pain after exercise to reduce inflammation.
TENS
TENS lessens pain by sending painless electrical impulses through electrodes into the muscles, describes Drugs.com. A signal passes through to the nerves, which then take messages to the brain. TENS signals can replace the sensation of pain in these nerves with a tingling sensation, changing the perception of the pain. TENS impulses may also increase the production of endorphins, a pain-relieving chemical made by the body.
Spine Universe states that there is documentation of greater than 50 percent reduction in pain with a TENS unit. Physical therapists often apply TENS during a therapy session and can also set up units for home use.
Active Modalities
After the acute phase of back pain is over, more active therapies are started by a physical therapist. "The New York Times" reports that exercise plays a beneficial role in chronic back pain. Stretching helps to restore flexion movements, which is critical to return the patient to full activities, states Spine Universe. Stretching of the leg muscles as well as the back is important, as tight leg muscles may inhibit correct posture and pull on the back.
Strengthening exercises work best for improving function of the back. The American Physical Therapy Association explains that physical therapist intervention includes strengthening of core muscle groups, including the abdominal wall and lumbar back muscles. Leg strengthening is also important so that the patient can properly lift objects using the legs instead of the back muscles.
Aerobic activities assist in bringing nutrients to spine structures. The discs of the spine have a poor blood supply and rely on aerobic exercise to circulate nutrients to these areas, according to Spine Universe.
