Physical Therapist's Guide to
Low Back Pain
If you have low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months. In most cases, low back pain is mild and disappears on its own. For some people, back pain can return or hang on, leading to a decrease in quality of life or even to disability.
If your low back pain is accompanied by the following symptoms, you should visit your local emergency department immediately:
- Loss of bowel or bladder control
- Numbness in the groin or inner thigh
These symptoms might indicate a condition called "cauda equina syndrome," in which nerves at the end of the spinal cord that control bowel and bladder function are being squeezed.
Signs and Symptoms
The symptoms of low back pain vary a great deal. Your pain might be dull, burning, or sharp. You might feel it at a single point or over a broad area. It might be accompanied by muscle spasms or stiffness. Sometimes, it might spread into 1 or both legs.
There are 3 different types of low back pain:
- Acute – pain lasting less than 3 months
- Recurrent – acute symptoms come back
- Chronic – pain lasting longer than 3 months
Most people who have an episode of acute pain will have at least 1 recurrence. While the actual cause of low back pain isn't often known, symptoms usually resolve on their own. Psychosocial factors, such as self-confidence and a perceived ability to cope with disability, have been shown to be predictors of who might not recover from low back pain as expected. We used to believe the cause of low back pain was related directly to the tissues of our body, but are now understanding the condition to be more complex.
Although low back pain is rarely serious or life threatening, there are several conditions that may be related to your low back pain, such as:
While we used to believe the above list contributed directly to low back pain, research has shown these conditions are also present in people without any pain (asymptomatic).
How Is It Diagnosed?
Your physical therapist will perform a thorough evaluation that includes:
- A review of your health history.
- Questions about your specific symptoms.
- A thorough examination that includes assessing the quality and quantity of your movements, and any movement behaviors that might put you at risk for delayed recovery.
- Tests to identify signs or symptoms that could indicate a serious health problem, such as broken bones or cancer.
- Assessment of how you use your body at work, at home, during sports, and at leisure.
For most cases of low back pain imaging tests, such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are not helpful for recovery. For example, in a recently published article comparing patients who received an MRI first vs physical therapy first for low back pain, the patients who received an MRI first spent on average $4,793 more (with similar outcomes in each group). If your physical therapist suspects that your low back pain might be caused by a serious health condition, the therapist will refer you to other health care professionals for further evaluation.
How Can a Physical Therapist Help?
Your physical therapist can help you improve or restore mobility and reduce low back pain—in many cases, without expensive surgery or the side effects of medications.
If you are having low back pain right now:
- Stay active, and do as much of your normal routine as possible (bed rest for longer than a day can actually slow down your recovery.)
- If your pain lasts more than a few days or gets worse, schedule an appointment to see your physical therapist.
Not all low back pain is the same, so your treatment should be tailored to for your specific symptoms and condition. Once the examination is complete, your physical therapist will evaluate the results, identify the factors that have contributed to your specific back problem, and design an individualized treatment plan for your specific back problem. Treatments may include:
- Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues
- Specific strengthening and flexibility exercises
- Education about how you can take better care of your back
- Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions
- Assistance in creating a safe and effective physical activity program to improve your overall health
- Use of ice or heat treatments or electrical stimulation to help relieve pain
Learn more about recommended treatments for low back pain.
Can this Injury or Condition be Prevented?
As experts in restoring and improving mobility and movement in people’s lives, physical therapists play an important role not only in treating persistent or recurrent low back pain, but also in preventing it and reducing your risk of having it come back.
Physical therapists can teach you how to use the following strategies to prevent back pain:
- Use good body positioning at work, home, or during leisure activities.
- Keep the load close to your body during lifting.
- Ask for help before lifting heavy objects.
- Maintain a regular physical fitness regimen—staying active can help to prevent injuries.
There is evolving evidence suggesting that the best strategy in preventing disability and care-seeking for low back pain is simply understanding what we are learning about the topic of pain. To learn more, read more about Pain.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat people who have low back pain. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic or musculoskeletal problems.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with low back pain.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of sports hernia. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs [erratum in: BMC Health Serv Res. 2016;16:444]. BMC Health Serv Res. 2015;15:150. Free Article.
Clark S, Horton R. Low back pain: a major global challenge. Lancet. 2018;391(10137):2302. Accessed August 30, 2018.
Foster NE, Mullis R, Hill JC, et al. Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison. Ann Fam Med. 2014;12:102–111. Free Article.
Delitto A, George S, Dillen LV, et al. Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42:A1–A57. Free Article.
Deyo RA, Mirza SK, Martin BL. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 2006; 31:2724–2727. Article Summary in PubMed.
Frogner BK, Harwood K, Andrilla CH, Schwartz M, Pines JM. Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Serv Res. 2018 May 23 [Epub ahead of print]. doi: 10.1111/1475-6773.12984. Article Summary in PubMed.
Reviewed by the editorial board.