Physical therapists (also called physiotherapists) help aid recovery from injuries, manage pain, improve health and fitness, and provide physical rehabilitation. Physical therapy is a useful treatment for lower back pain. It can help restore and maintain function, mobility, and wellbeing in people with acute or chronic pain and those who have undergone surgery.
If your doctor has referred you to a physical therapist, you probably want to know how long it takes and what to expect.
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Lower back pain is the most commonly diagnosed condition seen by physical therapists¹. Almost 65 million people² in the US report they have recently experienced lower back pain. Nearly 16 million adults (8%)² develop chronic or persistent back pain that limits their daily activities.
Common types of physical therapy include:
1. Passive physical therapy (modalities)
Passive physical therapy for lower back pain is carried out by a therapist, and while you are encouraged to provide feedback, you don’t need to be actively involved. The main purpose of these treatments is to help relieve pain, release tight muscles, improve joint flexibility, and ease stiffness.
Passive physical therapy examples include:
Electrical therapy (TENS, ultrasound, interferential, etc.)
2. Active physical therapy
You will need to be actively involved in this type of therapy. After an assessment, your therapist might recommend exercises or certain activities to help ease your lower back pain. Active physical therapy usually goes hand-in-hand with passive treatment to maintain improvements.
Actively participating helps promote long-term recovery and health, so it’s the primary focus of the majority of physical therapy for lower back pain.
Common types of active physical therapy for lower back pain include:
A 2018 study³ encouraged physical therapy as a good first step for patients with acute lower back pain to reduce their long-term need for medications or surgery.
Your physical therapist will carefully assess your movements, test results, medical history, and any other useful information to create a physical therapy treatment plan that will address your specific needs.
Physical therapy’s goal is to have a positive impact on your life, particularly if you're struggling with a debilitating condition like lower back pain. General aims of physical therapy include:
Increasing function and your ability to move
Helping you return to activities that you enjoy, like playing sports and going to the gym
Showing you how to prevent lower back pain in the future
Your doctor might refer you to a physical therapist as an initial treatment for lower back pain. This could last weeks or months, but your doctor may want to see if it works before considering more invasive treatments like corticosteroid injections or surgery.
Focussing on active therapy can be even more useful if your lower back pain lasts longer than 12 weeks⁴. Passive treatment tends to be more helpful for short-term pain, while people with long-term pain should focus on improving weak areas.
If you undergo surgery on your lower back, physiotherapy can aid your recovery. Surgery can take several months to recover from, and you might experience temporary stiffness, weakness, and swelling after the procedure that physiotherapy can help with.
Many people eventually experience significant benefits from low back surgery, but physiotherapy can help you achieve the best results. Your spine and surrounding muscles are complex — there may be weaknesses like muscle loss and joint stiffness that surgery alone cannot fix, and these will need to be addressed post-surgery. Studies⁵ following lumbar disk surgery show that physiotherapy patients experience improved spinal function and significantly reduced pain.
You will need to get the go-ahead from your surgeon and/or doctor before setting up an appointment with your physical therapist. The therapist will conduct an initial assessment that involves:
Reviewing your medical history
Looking at any necessary documents (x-ray, MRI, surgeon’s report, etc.)
Assessing your posture, scar tissue, function, and flexibility
The findings from this evaluation will help the physical therapist come up with a treatment plan. Common post-surgery treatments include:
If you have pain after low back surgery, your physical therapist may use passive treatments to help manage your pain. Some examples include:
A soft tissue massage around the surgery area — helps treat muscles that have become tight and stiff while you’ve been inactive after surgery
Using heat to improve circulation in your back and relax your muscles
Using ice to help reduce pain and swelling around the surgery area
A post-surgery exercise program can improve your movement while helping you gain strength and feel healthier. Your physical therapist will teach you exercises that are specific to your needs, like improving core stability, flexibility, and overall back strength. The ultimate goal is for you to become fully active again.
Your physical therapist might focus on strengthening the back’s surrounding areas, including your glutes, thighs, arms, and trunk. These areas might have been affected when you were suffering from lower back pain before your surgery, as they might have become weaker due to inactivity or compensated for your reduced back strength. You might do cardiovascular exercises such as treadmill walking or hydrotherapy to help conditioning and endurance. Your physical therapist will monitor your progress and adapt these exercises over time to suit your needs.
Once your surgery scar has closed, your physical therapist may massage the scar or teach you how to do this yourself. Scar massage helps prevent the area from drying out and tightening which can restrict your movement.
Preventing lower back from recurring
When you have gone through surgery, the last thing you want is for your lower back pain to return. Physical therapy can lower the chances of pain recurring and your therapist can show you how to avoid issues developing in the future by identifying risk factors.
Your therapist might advise you to restrict certain movements or activities, show you how to sit with the right posture, and teach you safe and appropriate exercise techniques. They will also help you recover as effectively as possible to lower the risk of problems recurring.
Most people experience lower back pain at some point in their life, particularly those who are inactive or work for long periods in front of a desk. Back pain isn’t usually cause for concern as it tends to resolve itself, but you should look out for signs that it’s time to get professional help.
Talk to your doctor before making an appointment with a physical therapist. They can identify the cause of your pain and rule out any underlying conditions. Physical therapy might not be appropriate for you, and a different type of treatment like medication or surgery may be needed. If your doctor thinks you could benefit from physiotherapy, they will make a referral.
Signs that you should see a medical professional include:
1. Tingling, numbness, and referred pain
If you experience any referred pain (symptoms traveling from the back to other areas of the body), it's time to see your doctor. This might be a symptom of sciatica, a painful spinal condition that causes pins and needles, tingling, or weakness in the toes, feet, bottom, or the backs of the legs.
Sciatica needs to be managed immediately to prevent long-term issues, such as muscle weakness, stiffness, and problems with sensation and movement.
2. Home remedies to reduce pain aren’t working
At-home remedies, like alternating hot and cold packs, sleeping with a pillow between your knees, or using a reclining chair can effectively reduce lower back pain. If they don’t provide any relief, it’s time to see a medical professional.
3. Lower back pain that lasts over a week
Make an appointment with your doctor if your back pain lasts over a week, particularly if it’s severe or affects your ability to do daily activities. Untreated lower back pain can lead to complications, and you should rule out underlying conditions.
4. Your pain was caused by an injury
If you sustain an injury that causes pain in your lower back, you might need to see a doctor. Left untreated, it could lead to long-term pain and disability. Your doctor will assess you and provide a treatment plan if needed which may include physical therapy.
Examples of injuries that cause lower back pain include:
5. Your symptoms become severe
Lower back pain symptoms can quickly go from being a nuisance to disabling. If you find it impossible to move, feel numb or weak on one side, experience bowel or bladder problems, or you’re hit with sudden and intense pain, see your doctor right away. They may carry out several tests to identify the problem before referring you to a physical therapist.
Physical therapy is a non-invasive, holistic treatment that can effectively help treat lower back pain and aid recovery from surgery. It can be passive, where the therapist provides treatment without involvement from you, or active, where you take an active role in therapy (this is particularly useful for long-term lower back pain).
You might need to undergo physical therapy for weeks or months depending on your individual needs and progress. Physical therapy is usually recommended as an initial lower back pain treatment, but if it’s ineffective, you might need medication or surgery.
If your pain lasts longer than a week or suddenly gets worse, make an appointment to see your doctor right away. After carrying out an assessment and health check, they may refer you to a physical therapist as part of your treatment plan.
Chronic back pain | Health Policy Institute