PHYSICAL THERAPY FOR THE SPINE

Questions and Answers

Types of Back Pain That Can Benefit from Physical Therapy

Physical therapy is often a valuable approach for managing and alleviating various types of back pain. Here are the key types of back pain that can benefit from a professionally guided physical therapy program:

Axial or Nonspecific Back Pain

Axial back pain, which lacks a clear, identifiable cause, is a common issue. This type of pain often arises from multiple factors, such as poor posture or excess body weight. Physical therapy for axial back pain generally includes:

• Stretching exercises to enhance flexibility.
• Strengthening routines focused on the lower back.
• Lifestyle modifications to address contributing factors like posture and weight management.

Sciatica

Sciatica is characterized by symptoms such as lower back and leg pain, usually due to irritation or compression of a spinal nerve. Although not a formal diagnosis, it can be effectively managed through physical therapy. Typical treatments involve:

• Extension and flexion exercises to improve spinal mobility.
• Lumbar strengthening exercises to support the lower back.
• Nerve and joint mobilization techniques to reduce nerve compression and pain.

Post-Surgical Pain and Healing

After spine surgery, physical therapy plays a crucial role in recovery. A structured therapy program can:

• Reduce fatigue and help regain energy levels.
• Facilitate a return to daily activities safely and efficiently.
• Prevent re-injury by strengthening the affected areas and improving overall body mechanics.

Physical therapy can thus be tailored to address various forms of back pain, aiding in recovery, pain reduction, and long-term health.

Physical Therapy for the Spine Includes:

Your physical therapist can assist with a range of therapeutic approaches, such as:

Exercise

The most crucial form of treatment for reducing pain and increasing mobility is exercise. Your physical therapist will recommend a set of low-impact exercises. These exercises will strengthen the muscles in your hips, abdomen, and spine. Also, they will help you stand, walk, and balance more steadily and reduce your risk of falling.

Here are some specific exercises that can help relieve low back pain:

Seated Hamstring Stretch

• Sit on a chair and place your heel on another chair in front of you.
• Keep your back straight and hinge forward at your hips until you feel a gentle stretch through the back of your thigh.
• Hold the stretch for at least 15 seconds, and repeat up to three times on each side.

Wall or Doorjamb Hamstring Stretch

• Lie on your back with one leg straight and the other leg resting against a wall.
• Hold this stretch for up to a minute, working up to three times on each side.

Kneeling Lunge Stretch for Hip Flexors

• Kneel on the ground with one foot flat on the floor.
• Place both hands on your thighs and distribute your weight evenly between your legs.
• Shift your hips forward until you feel a gentle stretch through the front of your hip.
• Hold the stretch for up to 30 seconds on each side. If kneeling is uncomfortable, modify by standing with one foot in front of the other, hands on your hips or a wall for balance, and shifting your weight forward.

Back Flexion Exercise

• Lie flat on your back, either on the ground or on your bed.
• Bring both knees to your chest until you feel a light, gentle stretch through your lower back and hips.
• Hold the stretch for 30 seconds, working up to three times. Consult with your medical provider if you experience any pain or discomfort.

Piriformis Stretch

• Lie flat on your back.
• Bring one knee to your chest, then pull your other ankle towards your shoulders.
• You should feel a gentle stretch through your hip on that side.
• Hold for up to 30 seconds, working up to three times on each side.

By incorporating these targeted stretches and exercises into your routine, you can effectively manage and alleviate low back pain. Always consult your physical therapist or medical provider before beginning any new exercise regimen to ensure it is safe and appropriate for your specific condition.

Understanding Your Core

In simple terms, the body’s core can be described as the area surrounded by the stomach muscles in front, the spinal and buttock muscles at the back, the bottom of the lungs or the diaphragm on top, and the muscles of the pelvis and hip at the bottom.

Why a Strong Core Matters

A weak core distributes weight unequally throughout the spine and into the legs, causing back pain or worsening existing back pain. Strengthening your core can significantly reduce pain and improve functionality in the lower back.

Core-Strengthening Exercises

Here are some easy-to-perform core-strengthening exercises recommended by physical therapists to help relieve back pain:

• Pelvic Tilt
• Cat-Cow Pose
• Bird Dog
• High and Low Planks
• Crunches
• Exercises using a Swiss Ball

These exercises are designed to build strength and endurance in the core muscles, providing the support your spine needs to function properly. By incorporating these into your routine, you can alleviate back pain and improve your overall physical stability.

Physical therapists typically recommend:

• Abdominal Strengthening Exercises: These help support your spine and improve posture.
• Back Strengthening Exercises: Essential for maintaining spine stability and reducing pain.
• Leg Strengthening Exercises: These are important for improving overall mobility and support.
• Aerobic Exercise: Low-impact activities like walking or swimming to enhance cardiovascular health and reduce fatigue.

Being involved in a consistent, guided exercise program is critical. It helps your body heal from the surgery and minimizes future episodes of back pain. Following a structured regimen, you can return to your normal day-to-day activities and avoid re-injury.

How Do Core-Strengthening Exercises Help Relieve Back Pain?

Core-strengthening exercises play a crucial role in alleviating back pain by targeting the muscles that support the spine and pelvis.

The Importance of Core Muscles

The core is the central region of your body, encapsulating muscles in the stomach, back, hips, and pelvis. These muscles work in harmony to stabilize your spine and enable you to maintain an upright posture.

How a Weak Core Contributes to Back Pain

When your core muscles are weak, they fail to support the spine adequately:

• Weight Distribution: Inadequate core strength leads to uneven weight distribution across the spine, resulting in increased pressure on certain areas.
• Muscle Strain: This imbalance forces compensatory muscles to work harder, often leading to strain and discomfort, particularly in the lower back.

Benefits of Strengthening Your Core

Incorporating core exercises into your routine can offer multiple benefits:

• Improved Stability: Exercises like planks and bridges enhance the stability of your spine and pelvis.
• Balanced Weight Distribution: Strengthening the core helps distribute weight evenly, minimizing strain.
• Increased Endurance: Building endurance in these muscles reduces the likelihood of fatigue-induced muscle strain.

Effective Core Exercises

Here are some exercises that can help:

• Planks: Engage your entire core to maintain a straight line from head to heels.
• Bridges: Focus on lifting your hips while keeping your back straight.
• Bird Dogs: Improve balance and coordination by extending opposite arms and legs while keeping your core tight.

By regularly performing these exercises, you can build a robust core that supports your spine, alleviating back pain and preventing future discomfort.

Targeted Muscle Strengthening

A strong spine needs strong hips and legs to support the lower body, and to walk, bend, and twist effortlessly. Inefficiency of the muscles in the hips and legs has been proven to cause spinal instability and pain. Your physical therapist may focus on exercises that specifically target muscles like the iliopsoas and hamstrings. Stretching exercises can activate and strengthen these muscles, improving coordination between the hip and spine. This coordination aids in the transfer of forces across the lower back, pelvis, and legs, reducing spinal instability and associated pain.

By focusing on both general and targeted exercises, your physical therapist can help you achieve a more stable and pain-free lower back.

Coordination

Before beginning any exercise program, speak with your doctor or physical therapist.

Stretching

Based on the results of your initial evaluation, your physical therapist will recommend specific stretching exercises for your spine, arms, or legs. Stretching and exercise are especially important for obese people. Stretching along with strengthening may slow the disease’s progression.

Symptom control

Learning to feel better and carry on with your activities is symptom management. Sometimes people worry that getting more active will make their symptoms worse or make them more painful. Your physical therapist will teach you how to increase your activity level without making your symptoms worse. Your therapist will work with you to determine your ideal activity levels and create a special plan to keep you active.

Large-scale studies have shown that physical therapy can provide up to 60% improvement in lower back pain and other symptoms. This significant improvement underscores how physical therapy helps restore the patient’s ability to perform daily activities with little to discomfort. By following a tailored plan designed by your therapist, you can achieve substantial relief and regain the ability to function in your day-to-day life.

Incorporating physical therapy into your routine not only helps manage pain but also improves overall mobility and strength. With the guidance of a professional, you can safely enhance your activity levels, leading to a better quality of life.

Daily activity training

Your physical therapist can show you how to bend and walk more easily, as well as how to get in and out of a chair, the bathtub, and the bed with ease. These guided therapeutic exercises are designed to strengthen your lower back muscles and condition the spinal tissues and joints. By participating in physical therapy, you can achieve several short- and long-term goals:

• Decrease painful symptoms in the lower back and/or leg.
• Improve low back function to tolerate daily activities as independently as possible.
• Increase the spine’s flexibility and improve its range of motion.
• Formulate a maintenance program to prevent the recurrence of back problems.

The exercises not only focus on immediate improvements in daily activities but also aim to provide flexibility and strength training to your entire kinetic chain. This holistic approach ensures that groups of body segments, joints, and muscles work together efficiently to support and perform bodily movements.

Use of modalities

You might use treatment modalities like heat or ice to help control your symptoms.

Manual therapy

Your physical therapist might employ gentle manual therapy (hands-on techniques) to help loosen up your spine and reduce stiffness.

Balance and walking training

You can use exercises and guidance to safely increase your balance and lower your risk of falling.

Specialized braces or taping

To support your joints, your physical therapist might apply tape or use specialized braces. In more severe circumstances, back bracing may be used.

Weight control

Obesity increases the likelihood that your upper back will have a more spinal impairment. Your physical therapist can advise you on nutritionists and assist you in increasing your activity levels. We always advise people to seek therapy for the following three reasons. Declaring that you will work out for an hour is simple. But things happen—the phone rings, there’s a problem at home, you become busy—and you either arrive in a half-hour or don’t. In therapy, you have an hour of undisrupted time to focus solely on your body’s healing. Additionally, if you have an appointment, you will feel more pressure to go.

The exercises’ actual mechanics make up the second factor. It can be challenging to perform the exercises on your own, and if you don’t do them correctly, some of them may even make your pain worse. A therapist can observe you to make sure you’re following all the instructions. Last but not least, physical therapy is a place to learn as well as a place to get better. Although you won’t stay in therapy indefinitely, it will give you exercises you can do at home and incorporate into your routine indefinitely.

Therapy & Recovery for the Neck Pain

A muscle strain, a sprain in a neck ligament or tendon, a disc injury, arthritic changes, or trauma can all cause neck pain. Furthermore, this can result from a neck strain from daily activities or an injury like whiplash. Physical therapists examine you to determine the source of your pain before prescribing therapy to reduce it. Exercises for flexibility, posture instruction, joint mobilization to ensure proper vertebral alignment and increase neck range of motion, massage, and strengthening and conditioning exercises are some of the possible treatments.

Passive and Active Physical Therapy

Physical therapy typically consists of these two elements:

• Passive physical therapy reduces back pain temporarily by employing heating pads, cooling packs, electrical nerve stimulators, and other techniques.
• Active physical therapy, which includes daily stretches and targeted exercises to strengthen the lower back for more stability; this, in turn, increases the production of muscle around the spine and discs, relieving pressure on the back

Spinal decompression therapy is a different type of physical therapy that treats lower back pain, neck pain, and pain brought by herniated discs. The best results from decompression therapy are seen in post-surgical patients.

General Therapy and Spine-Specialized Therapy

One of the ways to end pain permanently is to alter the back’s physiology by exercising. As a result, exercising will make the back stronger, more flexible, and injury-resistant. In contrast, while a general physical therapist may try for weeks to use heat, ice, or ultrasound to mask pain, research has shown that doing so does not have any long-term benefits. Consequently, the majority of health insurance companies no longer cover passive, feel-good treatments that involve heat or ice. Currently, the insurance industry believes you can complete this task by yourself at home.

Nevertheless, for certain types of back pain, a combination of physical therapy and lumbar epidural steroid injections may also be recommended by a patient’s physician. Specifically, these injections can provide immediate pain relief, complementing the benefits of exercise. In addition, physicians might also prescribe pain-relieving medication to manage acute pain flare-ups.

Moreover, physical therapists often prescribe self-treatments, such as heat and cold therapy. These methods, in turn, help to decrease pain and inflammation and improve tissue healing. Here’s how:

• Heat Therapy: Increases blood flow, oxygen, and nutrients to the affected area, promoting healing and reducing muscle stiffness.
• Cold Therapy: Reduces blood flow, which helps decrease inflammation and numbs sore tissues, providing relief from acute pain.

Incorporating these self-treatments can be an effective way to manage symptoms at home while following an exercise regimen to strengthen the back. The dual approach of exercise and targeted therapies offers a comprehensive strategy for long-term back health.

Objectives

The spine is a unique issue that requires specialized training. Every day, a large variety of patients with issues related to sore elbows, knees, or shoulders visit a general physical therapist. While general physical therapists are very adept at treating many sports medicine conditions, they frequently have very little knowledge of the most effective methods for treating particular types of back problems. As spine experts, we address a range of issues seen at the Southwest Scoliosis and Spine Institute.  These conditions can be very complex and require extensive training in the field of spine care. For instance, a spine-specific therapist’s main objective is to get the patient started on a customized home exercise program during their first visit. The second objective of the therapist is to quickly transform the patient out of therapy.

Manual Therapy

In manual therapy, the therapist’s hands are used to relieve pain. For instance, the spine therapist can treat soft tissue and vertebral areas with hands-on movements to relieve pain by employing specific techniques. Generally, this is accomplished by actively moving the joints and tissues rather than passively using a modality like ice or heat. Otherwise, a manual therapist differs from other physical therapists by having advanced training in the spine after completing their physical therapy education. Overall, this specialized training can be found in a variety of manual therapy philosophies, each of which uses particular pain-relieving methods to speed up patients’ return to function. Finally, no matter which school of thought is used, the best spine therapists keep away from passive modalities because they don’t offer long-term relief.

Orthopedic Spine Therapy

Physical therapy for injuries or pain coming from the back, neck, shoulders, and/or pelvis is known as orthopedic spine therapy. In addition, it is non-invasive because there is no need for surgery. Certainly, spine therapy is used to treat a variety of illnesses or as part of a post-operative recovery plan. For example, spine therapy targets the skeletal system, muscle groups, and intervertebral discs of the spinal column for adjustment, pain relief, posture correction, and functional improvement. In contrast, physical therapy takes a more generalized approach to rehabilitation. Therefore, physical therapists do not provide spinal therapy; orthopedic spine therapists do. Ultimately, up to 80% of all Americans may experience spinal pain at some point in their lifetime, which is surprisingly common. Indeed, it is frequently recurrent and can be crippling. Furthermore, if you are experiencing back pain, plan a visit with an orthopedic doctor.

Conclusion

Do you have questions?  Are you in Pain?  We invite you to talk with the experts.  Call the Southwest Scoliosis and Spine Institute for an appointment with one of our doctors.  We will talk and find a solution. In summary, seeking medical help for a spine condition from the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas can provide effective pain management, prevent further damage, improve mobility, provide individualized treatment, and support physical therapy that will also help heal the body. Finally, it is important to prioritize one’s health and well-being and seek medical help to address any issues related to spine conditions and the pain that accompanies these medical conditions.

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Spine Health: Rehabilitation and Physical Therapy after Spine Surgery