Back pain. The Physical Therapy approach. Part II

The purpose of our therapy is to decrease pain, increase function and provide patient with all information about back pain prevention. Most of my patients deal with back pain in unsuitable way. The painful sensation took them straight to bed, which made them feel a little better but prolonged the PT treatment. This is the first thing that we have to learn our patients. Bed rest is advised for only a few days if pain is severe. Prolonged bed rest can reduce muscle strength and lead to further disability. In the beginning of the treatment we should first decrease pain with passive physical therapy (modalities). Hot or ice pack, ultrasound, massage, electrical stimulation, TENSE could be used in that purpose. It depends on concrete case: some patients find more pain relief with heat and others with ice, for patients who have pain relief with TENS unit it can be used at home, some patients can't receive electrical stimulation because their anxiety of electricity… Modalities can be used in variety of situation all with just one goal to decrease pain.

In the same time we are creating, according to evaluation, a unique exercise program to improve flexibility of the spine, and strengthen back and abdominal muscles. Goal of this exercise program is to improve posture with maintaining good exercise routine and it's a part of our big role of patient's education. They should include exercise in their everyday schedule not just because it can help avoid recurrences of back pain, but also it helps reduce severity and duration of potential future episodes.

What should this exercise program contain? A cause of sore backs is often the lack of flexibility and strength in back and abdominal muscles. After the warming up we have to strengthen the back muscles, hip muscles and abdominal muscles. But, as we build strength, it should also proceed with stretching to improve flexibility. Stretching can make sustained relief of low back pain after the increase in motion of spine and soft tissue. The tight hamstring muscles are often connected with low back pain, and their stretching also makes progress in patient's condition. Exercise program should include relaxation as a best way to end our treatment.

This is one easy relaxation exercise: stand with your feet slightly apart; place your hands in the small of your back; keep your knees straight; bend backwards at the waist as far as possible and hold the position for one or two seconds.

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