Physical Therapy as a Back Pain Treatment
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Physical therapy uses different techniques, such as ultrasound, electrical stimulation, cryotherapy, massage, exercise, and heat in order to relieve muscle spasms, increase flexibility, strengthen muscles, relieve pain, and accelerate the healing process. A study in The New England Journal of Medicine found that the effectiveness of physical therapy for low back pain was about the same as that of chiropractic treatment and better than no treatment at all.
Physical therapists must graduate from an accredited physical therapy program, many of which offer master’s and doctoral degrees along with bachelor’s degrees. Most schools require two to four years of pre-physical therapy coursework before admittance. Like other physical treatment programs, physical therapists spend time in both the classroom and medical settings before graduation. After graduation, they must take exams to become licensed, and some states require continuing education to maintain that license.
After it is determined by a doctor or back specialist that you are a candidate for physical therapy—some time between two to six weeks after the onset of low back pain or sooner if the pain is severe or recurs frequently—you will meet with the therapist to determine the best plan of treatment for you. You will be asked how your back pain developed, how long you’ve had it, whether or not it’s recurring, what actions make the pain better or worse, and any relevant medical history you have. The therapist will also give you a physical exam of your spine movement, muscular flexibility, sitting and standing posture, muscle strength, reflexes, respiration, motor function, and repetitive movements. From there, he or she will determine which treatments will be best for you. There is some trial and error involved, so if one treatment doesn’t work to alleviate pain, the physical therapist may try something different.
There are basically two types of physical therapy, passive and active. Passive therapy is done to you and includes heat, cryotherapy, electrical stimulation, ultrasound, massage, and lontophoresis. In heat, or thermal, therapy, the therapist applies heating pads, heat wraps, or warm gel packs to the affected area. This works to increase the flow of oxygen to the muscle, allowing it to heal faster and relieve pain by softening muscles. In cryotherapy, cold is applied rather than heat, and is considered more effective than heat in reducing inflammation. Electrical stimulation sends mild electrical impulses to the nerves and spinal cord, which releases endorphins and blocks pain signals from the brain. Ultrasound heats the deep tissue and allows it to relax and stretch more easily. Massage breaks up scar tissue and encourages the relaxation of muscle spasms. During lontophoresis treatment, a painkiller and steroid are rubbed into the skin and a low level electrical current is applied to speed up the absorption of the drugs. It works similarly to transdermal patches used to quit smoking.
You participate in active therapy, and it includes stretching, strength building exercises, and aerobic exercise. A good physical therapist will combine passive and active treatments, as exercise is essential to treating back pain. The therapist will determine which exercises are best for your particular condition and supervise you in those exercises to ensure you are doing them correctly. You will likely be given stretches to be done daily, fifteen to twenty minutes of strengthening exercises, and thirty to forty minutes of low-impact aerobic exercise, such as swimming or walking, to be done three times a week.
You may feel some soreness or discomfort after active physical therapy, but it should go away in about twelve to eighteen hours. If it doesn’t, let your therapist know. You may need to change exercises or how you are exercising. Results vary depending upon the type of treatment done and the severity of symptoms, but a physical therapist should know in about two weeks if the treatment is working or not.
Massage Therapy
Massage therapy breaks down scar tissue and releases muscles from spasms. It is becoming increasingly more recognized as a form of medical treatment; a study by the American Massage Therapy Association found that 54% of healthcare providers encourage massage therapy, along with other types of therapy for back pain. Studies have shown that massage therapy is more effective than both chiropractic and acupuncture for relieving pain due to muscle spasms. The benefits of massage therapy include improved circulation, which helps alleviate muscle soreness; muscle relaxation, which helps muscles move without pain; and increased endorphins, the body’s natural pain relievers. If muscle spasms do not relax with massage therapy, that means inflammation is likely present and cannot be treated with massage. So if you know your back pain is due to inflammation, it won’t help to seek out massage therapy.
You should be aware that the kind of massage you receive in a spa is not the same kind of massage used to treat back pain. Swedish massage is the most common type of massage found in spas and similar places that offer massages, and while it feels good, it is too superficial to reach deep tissue and muscles and have any lasting affect on back pain.
The kind of massage used to treat back pain is called Neuromuscular therapy (NMT), or trigger point myotherapy. This type of massage works to relieve pain by balancing the musculoskeletal and nervous systems. NMT incorporates special massage therapy techniques, myofacial release, and stretching to relive both acute and chronic patterns of pain.
There are many massage training schools throughout the United State. Along with massage, neuromuscular therapists study neurological laws governing pain, the roles of soft tissue in pain, and palpation, as well as anatomy, physiology, and the function of the spine. In order to practice, massage therapists must be licensed and you should make sure that when looking for a massage therapist, you choose one that has had training in neuromuscular therapy. To find a massage therapist, get a referral from your doctor or contact the American Massage Therapist Association.
A neuromuscular therapist will ask you for all of the information that other therapists do and examine your spine to determine where exactly the pain is and what’s causing it. She will determine where nerves are compressed and where they are trapped within soft tissue. The therapist will work to relieve your back pain with her hands, fingers, elbows, and pressure bars, which are used to reach deeper into spinal muscles and tendons. She will use some kind of lubrication and start first on superficial tissue before moving deeper. This should not hurt, but you will feel pressure, and you may be sore afterwards due to the muscles releasing lactic acid. The therapist will also palpate trigger points, elevated neurological areas deep within the muscles. This may hurt initially, but the pain should go away quickly as the therapist continues to work. Back pain should respond to massage within four treatments over six weeks. If not, massage is clearly not the best treatment.
WATER THERAPY
Several types of water therapies exist and can be broken down into two very different groups: water exercise therapy and hydrotherapy. Water exercise therapy should be done only by a qualified physical therapist, while hydrotherapy may be done by a therapist but can also be done at home to relieve backaches.
Water exercise therapy has many benefits. The buoyancy of water supports the patient’s weight, allowing a greater range of motion when the person has too much pain to exercise on land. This makes water exercise therapy ideal for everyone who seeks relieve from back pain. Additionally, the water temperature should be warm enough to relax muscles, which also helps relieve pain. A physical therapist will have you do in the pool the same exercises you would do on land; they will just be easier to do. Some people transition to land exercises when their back allows it, some continue treatment in the water because they prefer it, and some incorporate both land and water exercises into the therapy.
Hydrotherapy for back pain relieves pain by loosening the muscles and ridding the body of toxins that produce pain and inflammation. Studies have shown that people who soak in a hot tub or warm bath have less stiffness, more flexibility, and tend to use less pain medication. Hydrotherapy consists of douches, sauna or steam baths, wraps, and hot baths with or without herbal additives. It has been used for centuries and is most popular in Europe. Many spas now offer various hydrotherapy treatments. The only risks involved are to people who are temperature sensitive and to those who have diabetes. You must be careful, though, not to get overheated.
To douche your back, use a hose hooked up to your bathtub faucet. Direct the stream of warm water over the painful area and toward the heart. The water should not splash, but rather wash gently over the skin. Do this for ten to fifteen.
Saunas and steam baths help relieve mild back pain because they stimulate the flow of blood, which relieves the pain of pulled muscles. You should not use a sauna if pregnant and never stay in longer than fifteen to twenty minutes. To keep from getting over heated, wipe your face frequently with a cold cloth. Drink plenty of water to keep from becoming dehydrated.
Warm baths are excellent for relieving mild backaches. Fill the tub with about 6 inches of tepid water and get in. Gradually add hot water until the water level in the tub reaches your naval. The final temperature should be no hotter than 104 degrees. Anything higher can induce a mock fever. Soak for fifteen to thirty minutes, and when you get out, wrap up warmly and go to bed. For even more benefit, you can add ½ cup of Epsom salts to the water to help draw toxins from the body. Essential oils can also be added to the bath. Some good ones for alleviating back pain are lavender, marjoram, rosemary, clary sage, black pepper, ginger, and birch. First mix two or three drops of the essential oil with two tablespoons of a carrier oil, such as sweet almond, peanut, olive, grape seed, or walnut oil, and then pour the mixture under running water. The mixture can also be massaged directly into the skin. To get a similar effect, tie ½ cup of herbs in cheesecloth and hang under the faucet so the water runs through the bag. Some good herbs for alleviating back pain are birch, German chamomile, white fir, wintergreen, and lavender. Using herbs and essential oils for healing is called aromatherapy; it promotes self-healing by indirectly stimulating the immune system.
Sometimes a physical therapist may do a heat wrap for your back pain, or you can also do one yourself at home. Moisten a cloth with warm water, wring it out, and wrap it snugly around the painful area of your back. Then wrap up in a dry cloth and next a blanket. Relax for 45-60 minutes. Herbs or hot mud may be added to the water for added benefit.
To Find out about when surgery may be suitable, you need our next installment, guess what, it is not as often as you think. Come back next week for our article on Surgical treatment of back pain or subscribe to our free , yes completely free newsletter.
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