A Physical Therapist’s Guide to Lower Back Pain

The lumbar region of the spine, also known as the lower back, resides between a person’s lowest rib and the top of the buttock region. Lumbar, or lower back pain, is a leading cause of disability worldwide. It is also one of the most common reasons for work-related absenteeism.

Are you currently suffering from a bout of lower back pain or have you developed chronic lower back pain? Then you’re not alone.

In this article, we’ll review the anatomy of the lower back region. We will look at some of the spinal issues that can lead to back pain. Next, we’ll discuss the many treatment “tools” that physical therapists employ to treat lumbar issues. In addition, we’ll also provide some tips on how to reduce/avoid a recurrence of lower back pain.

Anatomy of the Lower Back Region

The lumbar region consists of 5 vertebral bones stacked on top of each other. The L1 vertebral bone resides at the top portion of the stack. Underneath, in numerical order, reside the L2, L3, L4, and L5 bones. Between each bone resides a spinal disc. These doughnut-shaped discs consist of a tough, fibrous exterior that houses a jelly-like fluid on the inside of the disc. This interior fluid provides essential shock absorption and cushioning for the spine.

Multiple ligaments help to provide stabilization of spinal structures. Nearby muscles also play an important role in providing both stabilization and strength. When muscles surrounding the lower back area are strong and well-conditioned, they enable a person to walk, sit, stand, and comfortably engage in other strenuous physical activities.

An Aching Lower Back

Even the most physically fit individual can experience a short-term strain or sprain of one or more muscles or tendons. However, more chronic issues such as a herniated or bulging spinal disc, sciatic pain, or spinal stenosis are often due to degradation of key spinal components such as spinal discs, ligaments, muscles and/or tendons.

Over time, aging and/or a sedentary lifestyle can lead to weak back muscles. When the spine is not properly supported by strong back muscles, it can lead to compression of the discs between the spinal vertebrae. A spinal disc may begin to flatten and bulge over the side of an adjacent lumbar bone. A compressed spinal disc doesn’t provide as much shock absorption as a healthy disc. The bulging spinal material may press on nearby spinal nerves, resulting in additional pain. As this condition progresses, a spinal disc may herniate or tear. This allows the internal jelly-like fluid to spill out and press on adjacent nerves.

As areas in the lower back continue to degrade, tendons and/or ligaments often become overworked. They attempt to pick up the slack for degenerating discs, weak muscles, etc. Eventually, as spinal components continue to degrade, spinal stenosis (narrowing of the space surrounding the spinal cord) may occur.

Physical Therapy Treatments for Lower Back Pain

Whether a person is experiencing an acute or chronic case of lower back pain, physical therapists have many techniques at their disposal to help alleviate a patient’s pain and help them in the recovery process.

Pain Reduction Techniques

Initially, a physical therapist will typically focus on pain reduction techniques. This may include the application of heat, the use of a TENS unit to help reduce pain levels, and/or an ultrasound machine to help promote the healing of inflamed tissues.

A physical therapist will also likely employ manual (hands-on) therapy techniques. This can include soft and deep tissue mobilization along with mobilization of vertebral spinal components. These techniques can help relieve excessive muscle tension, promote the release of toxins and excess fluids from injured areas, and help to improve joint mobility. Other treatments a physical therapist may use include cupping, and/or cryotherapy (cold therapy).

Stretching Exercises

Once a patient’s pain is reduced, they are ready for the next step. This is the introduction of movement to injured areas through the application of gentle stretching exercises. Stretching helps to increase blood flow to injured areas. It helps to increase both tissue flexibility (muscle and/or tendon lengthening) and muscle/tendon extensibility, which pertains to the ability of proper functioning of individual muscle and/or tendon fibers.

The stretching exercises may include exercises designed to relieve tension in the lower back muscles. However, they may also include stretching the lower extremities such as the hamstring muscles in the back of the thighs and the front hip flexor muscles, along with the quadriceps muscles in the front of the upper thighs.

Strengthening Exercises

A therapist will then introduce exercises to strengthen areas that provide support to the lower back region. This may include strengthening exercises to improve posture and core strength. A therapist may also increase strength in the back extensor muscles and improve the strength of the lower extremities, especially the upper thigh and hip regions.

Strengthening exercises may be performed through the use of a weight machine, free weights, or exercise bands, with exercises targeting the entire back area including the upper, mid, and lower back regions. Exercises such as hamstring lifts and/or leg presses, which strengthen the upper quadriceps, may also be included.

Ergonomic Tips

A physical therapist will also include helpful tips on how to practice good posture while walking, standing, and sitting. The therapist can provide tips on how to position one’s seat in a vehicle before long trips, as well as other areas where a person may sit for long periods of time, such as at the workplace or at home. Lastly, they may make suggestions on proper footwear, and how to use a pillow or a brace to maximize comfort.

If you or someone you know has acute or chronic lower back pain, we can help! Please call Cawley Physical Therapy and Rehab at 570-208-2787 for an appointment today.