Physical Therapy Options for Lower Back Pain

By Dr. Stephen Cosentino

PRESIDENT OF EMPIRE MEDICAL TRAINING There has been a major change in the extended pain management for lower back pain injuries and new modalities for the prevention of lower lumbar pain as it relates to prescribing physical therapy.  Lower back pain in the United States has an annual healthcare cost of $82+ billion dollars.  Americans at the rate of 83% will experience disabling back pain and 65% of those will have a reoccurrence.  Low back strain in the workplace continues to be the #1 cause of work related injury and if left untreated or unattended may lead to further injury and occurrences.  Lower back pain is a self limiting disorder and therefore as part of Empire Medical’s 3-Day Pain Management Show we go over the various physical therapy options post treatment and for the prevention for future incidences. Categorizing and simplifying diagnosis for physical therapy is one way to direct physical therapy options available.  We can identify the symptoms of back pain but we do not really know what the triggers for and causes back pain.  Typical sources of lower back pain include:

• Spinal Osteoarthritis
• Facet Joint disorders
• Sacroiliac (SI) joint disorders
• Disc Bulge (derangement and/or herniation)
• Muscle or ligament strain
• Spondylolisthesis or Spondylosis

Once the pathology for pain is identified physical therapy options can be defined to support rehabilitation or strengthen the patient so future incidences of pain may not occur.  Latest research supports early motion with minimal rest is more effective as well as the various interventional methods available.  Minimizing temporary disabilities and educating patients is important but also who is the right candidate for physical therapy.  Your education in managing pain in patients should not just be limited to the alleviation of pain but also in the prevention of pain and general improvement and lifestyle for the patient.  Indications for patients that could benefit from physical therapy include:

• Chronic /Episodic back pain including muscle strain; positioning, or daily activities.
• Early intervention of 2 to 7 days post trauma injuries
• Non-neurological disorders or negative exam
• Referred Pain (muscular) symptoms

Interventional uses for physical therapies include both manipulation and mobilization for the identified pain and may include alignment, osteopathic, and motion techniques.  Massage is also sometimes prescribed for myofacial release, cross friction, and trigger point release.  Electrical stimulation is also prescribed including TENS, IFC, NMES, Iontophoresis, and the use of ultrasound.  The benefits of ultrasound may include increasing micro vascular to affected areas, phonophoresis to reduce inflammation, and to distract pain of arthritis or to supplement exercise.  Traction is also still prescribed for pain disorders or degenerative disc disorders and can be manual, positional or mechanical.  Other modalities may include decompression, exercise, cardiovascular, or muscle strengthening techniques.  Gait training is often a form of strengthening where patients learn to do daily activities in a safe manner and re-train muscles that have become atrophic.  This CME PRA Category 1 Accredited Pain Management Course incorporates many injury prevention concepts such as lifting, para-spinal muscle exercises, and body mechanics. These are some of the options available and utilized today for lower back pain, as part of your Interventional Pain Management Education we will go over all of your options available to prescribe physical therapy for your patient including education and weight management for patients.  There is a new standard of care expected with performing pain management procedures that is expected from conventional therapies to post-treatment options.  Understanding the benefits and need for physical therapy will allow for better outcomes.