Ouch! What can help your aching back?

• Spine pain is often caused by injuries resulting from inactivity.
• Exercise is a cornerstone of good spine health.
• Physical therapy may help improve your back pain.

Are you experiencing back pain? You’re not alone. Lower back pain is the second most common cause of disability within the US, with over 80% of the population experiencing it at some point in their lives.

Whether you are recovering from a recent acute injury, or your pain has slowly developed over time, physical therapy may help.

Dr. Tim Zepelak, DPT, a physical therapist at Swedish Pain Services, explains how physical therapy (PT) can reduce your pain, improve overall function, and get you back to doing the things you love.

What causes back pain?

Back pain is quite a common occurrence in everyday living. In fact, most people will experience it at some point in their life. The majority of back pain has no serious medical component to it and can result from muscle strains, overuse injuries, weakness, tightness, deconditioning, pregnancy, or obesity, to name a few. Even issues such as arthritis or disc bulges are quite common causes, but these also respond very well to therapy. Generally, spinal pain resolves once you restore movement to the area and start strengthening and reconditioning the tissues. Movement restores health and balance to the back. Your therapist can help evaluate your unique back pain situation and develop a treatment plan based on your needs.  

Do you see many spine-related injuries from recent fitness trends?

Injuries from CrossFit and other similar programs are on the rise. This is because many of the exercises are very intense and place a lot of stress on sensitive structures of the body. Because people want to look and feel better, they’re pushing beyond their body’s physical capacity.  

In a study published in the Journal of Strength and Conditioning Research, 73 percent of CrossFit athletes had sustained an injury during training, with 7 percent of these injuries requiring surgical intervention. Shoulder and back injuries are the most common problems.

What is involved in physical therapy?

The first thing we do is screen for “red flags” to rule out medical causes like fractures, infection, cancer, abdominal aortic aneurism, and cauda equina syndrome (pressure on the nerve roots that come out of the base of the spine). These red flags are rare (present in around 1-2 percent of cases). We also assess for neurological issues (present in around 5-10 percent of cases) and the need for other medical practitioners who may help in the patient’s care.

Treatment is then targeted toward the issues we are finding on the evaluation. If it’s tight, we loosen it. If it’s weak, we strengthen it.  If muscles are uncoordinated, we coordinate them. People often forget that movement is great medicine that keeps the body in balance.  On a cellular level, it fosters a reconditioning or regenerative process, depending on how you apply and dose it.

In fact, we have exercises not just to strengthen muscles or tendons, but also to desensitize nerves, improve brain functioning, condition cartilage, lubricate joints, improve blood flow, and hydrate discs.  

This process begins once we observe your body’s structure, function, and overall mechanics. Based on what we find, we design a specifically-tailored program unique to you. 

During each subsequent appointment, we assess how things are going and might incorporate additional techniques like hands-on manual therapy or modalities. Ultimately, the exercises and self-care you offer yourself at home are the most important aspects of your outcome. Patients have to be an active participant in their own health and well-being in order to see progress.

As PTs, we empower patients with knowledge and skills to mend their body. The body has a tremendous capacity for rebuilding, even with injuries or setbacks, but that capacity has to be harnessed. 

How long does it take?

In a traditional PT setting, patients generally come 1-2 times per week for 6-12 weeks.  The majority of patients see improvement within this time period.  

In a chronic pain clinic, such as Swedish Pain Services, people are dealing with more complex issues that involve an interdisciplinary team of physicians, nurses, psychologists, and physical, occupational, and biofeedback therapists. We have several outpatient programs that vary in frequency and overall length based on each patient’s needs.  

Intensive physical therapy sessions here use specialized movement strategies to re-teach the body how to move properly and comfortably again. Sessions also incorporate breath and brain exercises to regulate the nervous system and calm sensitive nerves. We have also developed specialized stretches that feed nerves more oxygen, nutrients, and blood. This helps lower pain by improving nerve health and giving them more space to breathe and move. Lastly, we educate on ways the body can produce its own natural pain medicine.  Everyone has a “drug cabinet in the brain” that produces pain fighting chemicals, but we need to know how to access it. One way is through aerobic exercise dosed at a specific intensity and duration.  

This all happens within the context of other disciplines and group therapies that guide patients on proper nutrition, activity modification, sleep hygiene, meditation, tai chi, yoga, relaxation techniques, ergonomics, and medication management.  The goal is that patients learn effective strategies to actively self-treat their own pain.

How can back pain be prevented?

Exercise is the cornerstone to good spine health. Overwhelming research has shown that getting people moving, in a way that’s comfortable and sustainable, goes a long way towards reducing pain, improving function, and getting people back to work.

Exercise also offers a huge range of additional benefits: histological, biomechanical, neuro-immune, and cardio-vascular. Aerobic exercise also provides pain relief by stimulating the body’s production of natural opiates called endorphins.

Other things that can prevent, or improve, back pain include losing excess weight, stretching, massage, acupuncture, and generally taking care of your body.

When should other types of treatments be considered?

Sometimes, people don’t respond to physical therapy. This can be for many different reasons. If someone doesn’t improve within 4-8 weeks, we team with additional providers for further evaluation. In some cases, surgery may eventually be considered.

If you’re interested in seeing a physical therapist, contact your primary care provider for a referral.

Find a Swedish physician in our provider directory.