In the beginning stages of treatment for back pain and injury, the primary problems tend to be inflammation, muscle spasm, and reduced mobility. The first goal of treatment is to reduce inflammation and muscle spasm. If the therapist proceeds too quickly to other treatments intended to enhance mobility or muscle strength, inflammation and spasm can be increased and the patient’s recovery can be delayed.
Treatments such as electrical stimulation and cold packs are often the first measures used to begin to control inflammation and spasm. These therapies are often more effective than medication in reducing the patient’s symptoms. Cold packs can be especially helpful when prescribed to the patient for home use to supplement in-office treatment, as the frequent application of cold therapy is the most effective means of reducing inflammation available. At the peak of inflammatory symptoms, using a cold pack for 10 to 15 minutes at a time as often as once every couple of hours will often decreased inflammation faster than even the best anti-inflammatory medication.
Once symptoms have decreased and the inflammation and spasm have subsided, treatments like massage and ultrasound may be helpful in alleviating soft tissue contraction and in improving circulation to damaged tissue to help with healing. At this stage, the severe pain is gone and the patient is primarily experiencing soreness and stiffness.
As symptoms continue to decrease, stretching and mobilization maneuvers can be utilized to increase the patient’s flexibility. Before transitioning to strengthening exercises, it is important to get the patient back to normal mobility as much as possible in order to avoid the reinforcement of abnormal movement patterns by strengthening the muscles.
Muscular strengthening and postural correction exercises can be introduced once mobility has returned to normal. In the case of back pain and injuries, poor posture and lack of muscle conditioning often contributed to the original injury or pain. It is especially important to re-condition the abdominal muscles and the muscles along the back of the spine to provide their normal postural support.
At least some of the exercises used in the physical therapy program should be those that can be done without special equipment, since it will be necessary for the patient to continue the exercises on their own once released from the physical therapist’s care. Rehabilitation machines can be very helpful during the patient’s treatment program, but they should not be the only type of exercise provided to the patient.
Through proper administration of treatment by the physical therapist, and proper instruction in appropriate self-care measures, the majority of back pain patients can recover and prevent future back problems.
