Written by Chris Dohrmann, DPT
Low back pain is the most common reason why someone will seek outpatient physical therapy services. It’s something that over 80% of Americans will deal with at some point throughout their lives. For some of these statistics see one of my recent Instagram posts. The intention of this blog is to expand upon how we address low back pain in clinic for our clients.
But first, I want to provide a bit more of a background before diving into treatment. Low back pain takes many shapes and sizes. For most folks it may be something that suddenly comes on, stops you in your tracks for a few days, and then begins to dissipate, until a few weeks later it’s an afterthought. For others, they’ve heard stories of Uncle Bob having it for the past 30 years, after days of working jobs with manual labor. Meanwhile, cousin Susie had symptoms while training for a marathon that gradually started and progressively increased until she finished the race. She hasn’t reported it since! Point being, pain itself is extremely complex (a conversation for a different post), which makes low back pain extremely complex as well. For this post specifically I want to focus mainly on recent onset low back pain. We’ll tackle other types in subsequent posts.
What’s the Process?
Now, for how we address it! In our clinic, our patient interview on Day 1 is where we truly start to understand how to address this thing. Is this something that started two days ago or two years ago? Has this been something that you’ve had 5 years ago, went away, and then came back 5 days ago? Understanding where you are coming from helps inform us on where we’re going. Not just knowing the history of the symptoms, but rather truly knowing the individual and their understanding of what’s happening in their body. There’s so many sources of information now that it’s impossible to not fall upon misconceptions, myths and misnomers and helping provide a glimpse of optimism for folks by having a discussion is extremely powerful.
Manual Therapy
For recent onset low back pain, one of the gold standard treatments is spinal manipulation. This is something that has been reinforced in clinical practice guidelines not only amongst physical therapists, but also of the American College of Physicians. It’s grade A evidence, first line of treatment, to begin someone’s journey back to feeling better. Now it’s nuanced, in how, when, if it’s applied becomes patient specific (as most things are). It is often combined with soft tissue mobilization and massage which also is recommended for use.
Exercise and Activity
Now manual therapy utilized with education is an extremely powerful tool. We reinforce the fact that the large majority of cases of recent onset low back pain will improve rather quickly. Also, we encourage folks to remain active with non provocative activities. Many of our patients being runners, cyclists, fitness athletes, live extremely active lifestyles. When we encourage remaining active. we encourage activities that either do no exacerbate current symptoms, or do things that are symptom reducing. Specific movements that are symptom reducing are often prescribed and that’s where we come in. However that’s not to say that trying to work up a light sweat through a hop on the assault bike, elliptical, or even a walk can’t help get the endorphins flowing and take a step back towards normalcy.
Manual therapy including spinal manipulation and soft tissue mobilization, empowerment of our patients and exercise are things we use everyday and in this case the sooner we utilize these things in an episode of care the better. Low back pain is unpleasant. Outcomes are more favorable with PT. So do hesitate to seek care as the sooner we can help facilitate that process the better the prognosis. If you have any questions or find this applicable to you give us a call!