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Back pain is tricky get the best with physical therapy treatment for low back pain


Should I go to a physical therapist for my back pain?

Physical therapists can help reduce and eliminate back pain. They are seen as the number one line of defense by physician groups due to a large body of evidence to its benefit. This is due to PTs having a strong understanding of the treatment of numerous back pain diagnoses and a large set of treatments they draw from. Most people should consider seeing a physical therapist for their back pain regardless of how long they have been suffering.


Should I go to a chiropractor for my back pain?

A chiropractor may be able to help your back pain. It is not uncommon however for a chiropractor to ask you to come for a prolonged time. The goal of any treatment is to get you to recovery and independence. If you go to a chiropractor you may find relief but relief should be over a longer period with a goal of no longer going to the chiropractor. If this is the case chiropractic may be of help.


Should I go to an acupuncturist for my back pain?

An acupuncturist may be able to help your back pain as some people find relief. There are a number of techniques they use and the research does not show a consistent benefit. The basis of the intervention should be reducing your pain and helping you become more independent. If you decide to try acupuncture a short period will help you determine if it will help.


Should I go to a massage therapist for my back pain?

Research supports the use of massage in the short term for low back pain. There is also evidence massage can help reduce painful points in the muscle tissue known as trigger points. Many people feel better after a massage which is why it is beneficial in the short term. Therapeutic and deep tissue massage both have research that supports massage for back pain. If you continue to have pain that reoccurs you may require other interventions to recover.


Is my weak core the cause of my back pain?

A weak core is unlikely to be the only cause of low back pain. Most people have some type of weakness in their core muscles regardless of pain. Some research does suggest that their is weakness in the core of people with back pain but this can also be due to over bracing or guarding. It is tough to know which came first in every case but people with back pain tend to have weak trunk muscles or “core” that can benefit from being addressed.


Penguin surgeon about prepped to perform surgery to signify the surgery topic of the article


Will minimally invasive surgery fix my issue?

The invasiveness of surgery does not make it a better surgery or worse surgery. If you have the indications for surgery it may help your issue but most people do not find full relief of their back pain with any type of surgery. Exhausting other treatments including quality physical therapy will help you determine if you should go the route of surgery.


How do I fix my subluxations?

Subluxations as defined by chiropractors: “a slight misalignment of the vertebrae, regarded in chiropractic theory as the cause of many health problems” do not hold up in research. In 1995, after nearly 100 years of chiropractic care research published by Nansel and Szlazak concluded that there is not a single appropriately controlled study to indicate any dysfunction in structures of the spinal column is a cause of organic disease. Another review in 2009 by Mirtz also failed to find any credible evidence supporting the chiropractic vertebral subluxation theory. In other words subluxations either do not exist or at minimum there is no evidence tying them to their affect on your health.


Should I use heat for my back pain?

Heat can provide a short term relief for back pain but does not have support for a long term solution. You can try heat for relief but only you can determine if heat will benefit you. People should not use heat during their physical therapy session because there is much more benefit for you to gain with hands on care, education, and exercise that will provide you both short and long term relief. If heat helps purchasing a heating pad can be just as effective and much more convenient.


Should I use ice for my back pain?

Ice has the benefit for desensitizing nerve endings and blunts the pain response. This means ice can help relieve pain for a short time. You get the best result in the first few days after injury with ice to help with inflammation. After the first few days ice may not be as important and if it does not seem to help with your pain you do not need to continue to use it. Heat and cold have both been shown to help acute low back pain. Only you can choose which is best for you.


Do I need traction?

Traction has been shown to benefit people with nerve pain that does not respond to other interventions. In general if you do not have leg pain related to your back pain then it probably will not benefit you more than other treatment. Other treatments are more effective and help people get better faster. Traction will often not be the first choice of treatment due to better initial options. If you feel better with traction or feel like you need it discuss it with your physical therapist who will go over the potential benefits.


Do I need an inversion table to relieve my pain?

Like traction an inversion table may help your pain but for most people other treatment options are cheaper and better. Traction is the most effective in the short term and very few people have good control of their symptoms when they continue to need traction. If you have not found relief with quality therapy then it may be an option. Because of the cost of an inversion table and the minimal benefit most people should not get an inversion table to attempt to relieve their pain.


Sound waves and electricity are used to treat low back pain


Will ultrasound help my back pain?

Ultrasound treatment for low back pain does not have evidence to support its use. Research shows that ultrasound is just as effective whether the machine is on or off. Patients should avoid the use of ultrasound at this time as it does not appear to support the recovery from back pain. Your time will be better spent on other treatments for your low back pain.


Will TENS help my back pain?

TENS or electrical stimulation can help people in pain. The benefit can last up to 24 hours which depends on the dosage. For the longest relief a patient must use motor or noxious TENS. This means you get a contraction of the muscle (motor) or you turn up the TENS to where you experience pain with the treatment (noxious). These types of TENS have been shown to be the most effective.

There are a number of articles that support the use of TENS for pain relief. Most research supports its benefit to help people with chronic low back pain. For acute low back pain it may also have a benefit but is not the first line of treatment. TENS can help with pain relief in those with back pain which helps you increase your activity level. This ultimately supports recovery and can provide non medication pain control. With fewer side effects than medication TENS can be a very good option to help people in pain.


I have flat feet, do I need an insole or new shoe?

There is some research that shows people with flat feet may have an increase in back pain. If you have pain after a change to your feet such as surgery an insole may help. Acute pain however you shoe is unlikely to be the only cause of your back pain.  A full lower extremity screen and gait is part of your physical therapy examination. Your PT can help with any modifications and suggest any changes to footwear you need.


Do I need a heel lift?

Sometimes people use a heel lift to help their pain. If it provides you relief it may help in the short term. Many people do not need a heel lift despite leg length differences. This is because people do not develop leg length differences over time without other things such as osteoporosis and fracture. The goal of therapy should be to help control and eliminate your symptoms and a heel lift may help but is unlikely to be a long term solution.


My friend got better with a certain treatment should I try it too?

Every person responds differently to each treatment. You should discuss the treatment with your therapist and they will be able to help you figure out if the treatment is right for you. You will discover the pros and cons of the treatment with your therapist and will be able to make a decision. No treatment is one size fits all.


medication should not be a treatment for low back pain


Is there something I can take to help my back pain?

Physical therapists are unable to advise on medication or supplements to take for back pain. Although there are a number of medications people will take for back pain the guidelines by the American Academy of Family Physicians are clear. The goal is to not use medications early and if a patient desires medication the physician should prescribe NSAIDs or muscle relaxants. This holds true for both acute and chronic back pain. The guidelines further state that a physician should only prescribe other medications if the patient completes all other treatment options without relief.


Can yoga help back pain?

Yoga has been shown to be effective for back pain. Like most exercise its benefit appears to be accumulative. This means that you should continue to do yoga if you find it relieves your back pain. It is often when people stop their exercises symptoms return. If you enjoy yoga and consistently do yoga it can help benefit your overall spine health.


I heard flexion (bending forward) can help does it?

Less than 8% of people find relief of their pain with flexion movements. This makes sense as most of our day we are in a bent position. If your symptoms increase with sitting, driving, and bending forward it is unlikely that bending forward is the exercise you need to get rid of your pain. Although unlikely a physical therapist can help determine if this intervention is right for you.


Specific movements can help low back pain


I heard extension (bending back) can help does it?

About 60% of people feel a positive benefit with bending back. Although not for everyone it is the most common movement to help control and eliminate back pain. If you find relief of your pain with walking bending back may be a movement that will help you recover. This is part of your examination when you see a physical therapist who will help you determine what exercise or movement will help eliminate your symptoms.


What is dry needling and can it help low back pain?

Dry needling is the use of small needles to specifically stimulate tissue to reduce irritability and improve function. This is similar to trigger point injections with only mechanical stimulus without medication. PTs primarily use dry needling to reduce muscle trigger points and allow for improvement in muscle function. This has been a highly researched PT intervention in the last 5 years and certain people see a very positive response to treatment.

Dry needling may help people with back pain with more research supporting its use. For people with back pain with muscle activation dry needling can help relieve back pain in the short term and help hasten recovery. When it comes to treatment of low back pain usually people require multiple interventions along with dry needling as a way to improve muscle function to help them move better.


Are there exercises I should do to help my back pain?

The most common exercise to reduce back pain is extension of the spine (bending backward). This does not mean that it works for everyone but research indicates it may help up to 60% of people with back pain. This works extremely well for self treatment. Exercise in general does also have a protective effect against back pain. A physical therapist can help you reduce your pain and discover what exercises are best for you.


Should I take Opioids for my back pain?

Opioids were initially for severe pain that would cause people to go to the hospital. They have since seen an increase in use among people with chronic pain which has led to addiction and abuse. The current recommendations from the American Academy of Family Practice state Opioid medication should only be considered when someone has failed all other treatments and leave a person with no other options. This means that someone should exhaust all other treatment options prior to taking this highly addictive medication.


having an ergonomic setup means your desk as well as your chair


Can a change in desk setup help back pain?

An ergonomic setup can help reduce back and neck pain. Specifically the change in how you position yourself in your chair is important. Additionally you should keep all items you use regularly as close as possible and if you use a screen keep it in front of you. In regards to chair height you should be able to comfortably reach the keys with your feet on the floor which sometimes requires a stool. Our article on if ergonomics will benefit you can be found here.


Are there any problems with going with a new treatment?

Healthcare treatment is always changing but the risk that people face with new treatments is lack of long term studies and side effects. There are many treatments that have not withstood the test of time. If you have not improved with the current most effective treatments you may want to explore newer treatments. If this is the case remember the benefits are often exaggerated and potential side effects are underplayed.


My back pain is worse but I no longer have leg pain, is my treatment working?

When your leg pain reduces or goes away this is centralization and is a good sign. When you have pain in your leg, when it is from your back, it is due to nerve irritation. Most of the time people see less back pain after their leg pain goes away but some people feel worse in their back. This is something your PT can help guide you through to reduce the pain in your back. If you no longer have leg pain but your back pain lingers see a PT to help determine what other steps you need to recover.


What is an adjustment and do you do them?

A spinal adjustment or chiropractic adjustment are terms in use by chiropractors to describe their approach to spinal manipulation, some osteopaths use these terms as well. There is no evidence supporting the movement of joints to put them back in place. There is a significant amount of high level research on spinal manipulation in PT and medical literature that has shown its benefit. Because of terminology rights in Pennsylvania and other states physical therapists have begun to define this type of treatment as an “end range high velocity low amplitude thrust of a joint”. There is a large crossover in hands on techniques chiropractors, physical therapists, and other providers use and you will find similar techniques called different things.


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