Physical Therapy for Chronic Back Pain

I’ve had low chronic back pain for 8 years and don’t know why. It hurts to walk for long periods, play with my kids and garden in my yard. My doctor says that tests (MRI, x-ray) are normal and wants me to take narcotics, but I don’t like them due to side effects. Chiropractic, acupuncture and massage help reduce pain but it comes back within a day. Exercise also makes it worse so I haven’t done this for years. What should I do?

– John W.

 

Chronic low back pain is a common problem.  It is the most common medical complaint worldwide and #1 cause of work-related disability.  Chronic low back pain associated costs are incredible: according to JAMA, expenditures for pain medications increased 423% from 1997-2005 due not only to more prescriptions, but also using brand-name medications over generic drugs.  Costly imaging tests are often done as patients think it will give them the cause for their chronic low back pain and doctors may want them for liability reasons, even though there’s little correlation between imaging and chronic low back pain.  For example, did you know that ~90% of people with a herniated disk have no back pain?  The reason: there are too many sensitive tissues (e.g., nerves, disk, joints, ligaments) together in a small space in the low back to be 100% sure what’s causing pain.  In other words, it’s rare to know what the cause of your chronic low back pain is.

A physical exam is necessary to provide credible and reliable recommendations for chronic back pain.  However, here are some general suggestions:

  • Physical therapy/exercise therapy.Dumb bell Squat for Chronic Back Pain  The most compelling data you provided was that your chronic low back pain increases with activity, which means you are not moving in a safe manner.  For example, strengthening the hip and thigh muscles is crucial to treat and prevent and treat chronic low back pain, but doing this safely is extremely difficult to do without close, professional supervision (i.e., licensed physical therapist).  See the attached picture of a dumbbell squat exercise and pay close attention to the amount of bend in the model’s knees and minimal arch in her low back.
  • Lose body fat.  I don’t know if you’re carrying excess body fat, but it’s likely because you’ve been sedentary.  Research shows a correlation between obesity and chronic low back pain, so in addition to exercise you need sound eating habits.  Generally, combine lean protein and complex carbohydrates at each meal, drink mostly water and limit meal sizes to about 400 calories.
  • Stretch.Leg Stretch for Chronic Back Pain Tightness in your hamstrings, thighs, buttocks and pecs can all contribute to chronic low back pain.  Before you start a stretch, carefully establish a comfortable low back/pelvic position, then gently move into the stretch and hold for about 60 seconds, 7 times per day.  However, the best results to lengthen tight tissues come from holding a stretch in a low-intensity position for 15-20 minutes (should be set up by a physical therapist to avoid injury).   See the attached picture of a standing hamstring stretch and pay close attention to the amount of forward lean in the model’s trunk (there’s very little, as he’s turned her pelvis toward the stretched leg’s foot) and minimal arch in his low back.
  • Continue doing things that provide relief.  As you learn to exercise safely and effectively, you’re likely going to have discomfort until you get techniques right.  Continue chiropractic adjustments, etc., if you get relief but understand that exercise should be the emphasis of your program.

If you make an honest attempt at exercise-based physical therapy and the pain persists, surgery may be warranted.  The best neurosurgeons are those who encourage patients to exhaust conservative options before surgery.  Jordi X. Kellogg, MD, a neurosurgeon in SE Portland specializing in artificial disk replacement, says, “Surgery can provide substantial relief for many, but a healthy lifestyle incorporating exercise and sound nutrition is crucial to possibly prevent surgery and for optimum surgical outcomes.”

While the “quick fix” for chronic low back pain still eludes medical experts, supervised, professionally prescribed physical therapy can be a cost-effective treatment addressing the “culprit” of most chronic low back pain cases (i.e., weakness, inflexibility).  While this approach takes time and effort, isn’t it better to change your oil instead of unplugging your oil light?

Email questions/comments to colin@chpt.org.

Colin Hoobler, PT, DPT, MS is a Doctor of Physical Therapy at c.h. Physical Therapy.

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