Physiotherapy Treatment For Lower Back Pain: What We Do And Why It Works
As a physiotherapist, one of the most common conditions we treat is low back pain. It can affect people of all ages and backgrounds and can have a significant impact on people’s daily lives. Fortunately, there are numerous methods to help improve lower back pain and prevent it from returning. Ideally, we would have strategies in place to prevent back pain from happening in the first place. Nevertheless, when pain does happen, there are multiple treatments available to alleviate discomfort and diminish recurrence.
Here, we’ll examine various physiotherapy treatments for lower back pain, why they work, and their role in easing discomfort, preventing re-injury, and improving quality of life.
Back Physiotherapy 101: Move Early & Move Often
Movement is the number one thing we need to do when we are experiencing pain. You may often hear a physiotherapist say: “When you're in pain, you need to move".
Movement helps desensitize your body to pain. When you don’t move, your body can become extremely protective and fearful of movement which can heighten how you experience pain. When we move, our system starts to understand that movement is OK and it becomes less protective. As this protection subsides, your body starts to relax and trust itself. This means that you will likely become less fearful of pain flare-ups and re-injury. This decrease in protection also leads to a lowered experience of pain.
We need to move early and we need to move often. I have many of my clients move every hour in some capacity early on in their rehab journey. The only time this advice does not hold true is if your doctor or surgeon has explicitly told you you should not move a certain way. This is a very rare situation which is usually associated with bone fractures that require immobilization to heal correctly.
When you are experiencing pain, normal movements can often aggravate your pain. You may need to start very small and test small movements to see what you can tolerate. As the pain subsides, you can move in larger movements and more directions. Your physiotherapist can assist you in developing a movement routine that is suited for you. For a quick example, see this video.
Lifestyle Is An Important Part of Physio For Lower Back Pain!
Various lifestyle factors can put excess strain on our body's systems. When more stress is placed on our system, our tolerance to pain goes down and we experience greater pain. When less stress is placed on our system, our tolerance to pain improves and we experience pain to a lesser degree. When we talk about the body’s stressors, it can include, but is not limited to, things such as diet, hydration, mental health, exercise habits, sleep, smoking and alcohol use. These habits can either increase stress/inflammation in our body or reduce stress/inflammation in our body, which changes how we experience pain.
Improving even one of these habits can improve how we experience pain. This may seem like a complex concept, and it is! As physiotherapists, we take whole courses about the science of pain. For now, remember that the healthier we are, the less stress is put on our body. Lower stress on the body correlates with a lower experience of pain.
It is important to ask questions like:
How can I be healthier?
How can my physiotherapist help me be healthier?
A physiotherapist's job is to help you figure out what you can do to improve your overall health and help you develop realistic plans and goals to address them.
Education And Self-Management For Back Pain
Education is an important aspect of low back pain treatment. After a thorough assessment, a physiotherapist will be able to provide individualized information on how to manage your pain and get you back to what you want to do. This can include guidance on diagnosis and prognosis, a customized rehab plan, education around pain and strategies on how to manage pain. A physiotherapist can also help you modify your posture and adapt your environment at home, work or school to reduce pain and chance of re-injury (1). The goal is to give you the information you need to effectively manage your pain as independently as possible!
Exercise Can Reduce Your Lower Back Pain
Evidence tells us that there is no one best exercise, or type of exercise for reducing lower back pain (1). We wish there were as it would make our jobs easy! The best exercise is the one that you can both tolerate and enjoy. Often, one of the best exercises in rehab is simply walking. Walking is an act of repeated gentle back movements that is tolerated by most people even if they are in pain. As we spoke about earlier, gentle frequent movement helps your system calm down and helps desensitize it to pain.
Exercise that raises your heart rate has the added effect of reducing inflammation in your body. As we talked about earlier, the lower the inflammation in your body, the less sensitive your body is to experiencing pain. Furthermore, when you exercise your body releases exercise induced endorphins. These chemicals actually inhibit pain signaling and act as a natural pain reliever.
Engaging in exercise is an important step in the recovery process. There is no right or wrong way to do this. Get your heart rate up if possible and find something you enjoy!
Back Physiotherapy 102: Gradual Loading & Strength Training
We have a saying in rehab: calm it down, build it up. Essentially, this means that the first step in recovery is pain management. After the pain is under control, we need to build strength. In fact, the goal is not just to build strength to pre-injury level but beyond!
Most injuries are the result of putting more stress on our bodies than they can handle. As we talked about previously, stress is not just physical. A component of the stress will be physical. When combined with working overtime, not getting enough sleep, poor nutrition or any number of other factors, we can get injured doing a task that is normally routine.
After an injury, if you build yourself back up to the same strength you were before the injury, then the same combination of stressors that initially caused injury will likely cause injury again. However, if you build up to be stronger than pre-injury, your chance of re-injury is significantly reduced.
Building strength doesn’t happen all at once. Gradually loading the back is an important part of your recovery. In the beginning, this may look like simply moving or stretching in whatever way you are able. As your back calms down we need to build it back up. This means strength training and weight lifting. If this is something that makes you nervous, don’t worry, you’re not alone! A physiotherapist can help you develop a strength training program that fits your specific goals and needs and addresses any anxiety you may have.
And Finally, The Back Pain Treatment You Thought We Missed: Manual Therapy
Manual therapy is a hands-on approach used to reduce pain and improve mobility. Manual therapy includes techniques such as mobilization, massage, soft tissue mobilization, and hands-on stretching. Evidence shows that manual therapy can be a key part of calming your system down and managing your pain (1). The type of manual therapy used will be dependent on your needs.
Manual therapy helps manage pain by bringing neurochemicals to the area of treatment which can provide pain relief. This can open a window for you to move more with less pain. Just remember, manual therapy is a treatment - not a cure! To permanently cure your lower back pain you need to follow the rest of the advice in this blog. So get moving and start building strength!
Conclusion
Lower back pain can be a debilitating condition that can greatly impact people's quality of life. However, with the help of a physiotherapist, there are various treatment options available to help manage pain and prevent future injury. Education, exercise, strength training, and manual therapy all have a key role in improving function, reducing pain, and getting you back to the activities you love. A physiotherapist is key to individualizing these interventions to match your specific needs and goals. If you are experiencing low back pain or have more questions, please reach out to us via email, phone or book online here. We are here to help you get back to what you love!
