It’s the rare adult who has not had low back pain at sometime during his/her life. Fortunately, most episodes of low back pain will heal with time. Approximately 50% of patients will feel relief within two weeks and 90% within three months, regardless of the treatment. The majority of low back pains are due to muscular strain which will resolve with time because muscles have a good blood supply to bring necessary nutriments and proteins for healing to take place.
For persons with low back pain that lasts more than two or three months, or with predominantly leg pain, a specific and definite problem is often the source of the pain. In younger adults (20-60 year olds) a disc is likely to be the pain generator. Specific causes include: lumbar disc herniation, degenerative disc disease and isthmic spondylolstesis. In older adults ( over 60 years old) the source of pain is likely to include: facet joint osteoarthritis, lumbar spine stenosis or degenerative spondylolstesis.
When low back pain episodes last between two and six weeks or if they become frequent, it’s time to consider physical therapy for treatment. In general the goals of physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences. Physical therapy may start with passive therapy modalities which will focus on decreasing the pain. These can include heat/ice packs, Iontophoresis which delivers steroids through the skin with an electrical current, and TENS units which is a transcutaneous electrical nerve stimulator, and ultrasound. These you can talk to your physician and physical therapist about. In addition active physical therapy is necessary to rehabilitate the spine. This can include stretching, strengthening/pain relief exercises, and low-impact aerobic conditioning.
Active exercises which are done routinely, provides people with a means to help avoid recurrences of low back pain and help reduce severity and duration of future episodes of pain. The first part of any program is stretching. Almost everyone can benefit from stretching the soft tissues–muscles, ligaments and tendons–around the spine. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and limitations in this motion can accentuate pain. Persons with chronic pan may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that meaningful and sustained relief of low back pain follows the increased motion.
The hamstring muscles seem to play a key role in low back pain as persons with this type of pain tend to have tight hamstrings. It is not known which comes first, but it is clear that hamstring tightness limits motion of the pelvis and can place stress across the lower back. A hamstring stretching routine should include applying pressure to lengthen the muscle for 30-45 seconds at a time, one to two times a day. Pressure to the muscle should be applied evenly and bouncing avoided as this could trigger a spasm, Here are some ways of stretching the hamstring:
- Bend over at the waist, with legs straight, and try to touch your toes. Hold this stretch.
- If this is too difficult, less strain is applied to the back by sitting in a chair and placing the legs straight out in front on another chair. Then reach out to try and touch the toes one leg at a time.
- An easier way is to lie on the floor and use a towel wrapped behind the foot to pull one leg up and straighten it. Hold the stretch.
- Another less stressful option is to lie on the floor with the buttocks against the wall, and place the foot up against the wall and then try to push the knee straight one leg at a time. Stretching should be done daily. It is best done each morning when you arise or when you go to bed at night. With time the hamstring will lengthen, reducing the stress on the back
Strengthening/pain relief exercises are used for specific conditions. McKenzie exercises and dynamic stabilization exercises are two physical therapies that can be beneficial. McKenzie exercises, named after a physical therapist in New Zealand, try to extend the spine to reduce pain generated from the disc space. It is also thought to reduce the leg pain due to a herniated disc. In dynamic lumbar stabilization exercises the physical therapist first tries to find the patient’s “neutral” spine or position that allows the patient to feel most comfortable. The back muscles are then exercised to teach the spine how to stay in this position. These can be rigorous so they are not recommended for the elderly or persons in significant pain.
The third way to strengthen the low back is low-impact aerobic conditioning. This is useful for both rehabilitation and maintenance of the lower back. Aerobically conditioned persons will have fewer episodes of low back pain and will experience less pain when the episodes occur. Well-conditioned persons are more likely to stay functional whereas those persons with chronic low back pain who choose not to work on aerobic conditioning should expect to experience the gradual loss of functional capabilities. Aerobic exercise should be continuous in order to increase heart rate and keep it elevated. It is thought that 30-40 minutes of aerobic exercise has the added benefit of increasing the production of endorphins which are pain fighting molecules produced by the body. There are several types of aerobic exercise that are gentle to the back and, done on a regular basis, are highly effective in providing conditioning.
- Walking: Walking two to three miles three times a week is beneficial for many aspects of one’s life including conditioning of the back, and improving longevity and mental capabilities.
- Stationary bicycling: This exercise is less stressful on the back than walking and is an alternative
- Water therapy: This can be an excellent therapy which minimizes stress on the back. It allows for mobilization with less pain and as a beginner therapy allows for the transition to land exercises. It is especially useful for people who are in extreme pain and for the elderly for whom it may the most effective therapy.
Years ago when I had back surgery for a herniated disc I too attended physical therapy. The exercises prescribed were described as necessary to form a muscle girdle around the body to support it. I became a believer then and began my daily aerobic exercise as soon as I was cleared to do so. Barry A. Evans, MPT, who is a physical therapist at St. John’s Hospital in Tulsa, shared these exercises. They are similar and the same as those I learned years ago. He starts people with 10 repeats twice a day. Hold the stretches for 10 seconds, unless stated otherwise to start and work up to 30 – 45 seconds.
Grasp behind one knee and pull toward chest.
Feel stretch in lower back and buttock area.
Breathing deeply, hold the position and count out loud 20 seconds.
Repeat with other knee.
Repeat 10 times 2 times a day
Back 3- Pelvic Tilt
With feet flat and knees bent, flatten lower back into bed
Tighten stomach muscles
Hold and count 10 seconds out loud
Repeat: 10 times, 2 times a day
Back 4- Pelvic Tilt Using the Buttocks
Tighten buttocks and flatten lower back
Count out loud 10 seconds while doing this
Repeat: 10 times 2 times a day
Back 14- Knee Rocks
Lie on back, with knees bent and together, feet flat
Slowly lower knees toward the side. Go as far as comfortable.
Hold 20 seconds to start
Repeat: 10 times 2 times a day
Back 6- Pelvic Tilt Double Arm Raises
Maintaining a pelvic tilt, raise both arms over the head, keeping the lower back flat. Return slowly.
Repeat: 10 times, 2 times daily
Back 11- Press Ups
Place hands in a position for half push up.
Press top half of body upward using arms
Let lower back sag. Hold 10 seconds
Repeat: 10 times 2 times daily
Back 10 -Elbow Prop
Prop body up on elbows for 10 seconds to start.
Slowly lower it.
Repeat: 10 times 2 times daily