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Physical Therapy for Lower Back Pain

Physical Therapy for Lower Back Pain

Individuals who are experiencing chronic, debilitating lower back pain are typically referred for physical therapy. This non-surgical treatment approach is often recommended for a specific period (e.g., 4-6 weeks) before determining whether more aggressive forms of treatment, including back surgery may be necessary. The main goal of physical therapy is to decrease back pain, increase mobility, and restore function of the bones or muscles in the back. This treatment approach also ensures that individuals learn maintenance strategies that help prevent additional back problems in the future.

Physical Therapy for Lower Back Pain

For people whose lower back pain does not respond well to over-the-counter pain medication or resolve on its own in a short period of time, physical therapy is often recommended. An individual who needs surgery may also be given a referral for physical therapy as the probability of experiencing positive outcomes as well as a quicker recovery increase when an individual’s body is in optimal physical condition. However, a physician should conduct an initial examination to identify the potential cause of the lower back pain. The examination is also necessary to rule out any potential contraindications for physical therapy (e.g., tumor, fracture).

Unless a serious condition is present or emergency surgery is required, most individuals benefit from working closely with a highly skilled physical therapist. The therapeutic process aims at improving posture and bodily movement as well as developing an at-home exercise program for prolonged improvement. A therapist also monitors whether sufficient progress is being made. Accordingly, physical therapy involves two primary forms, which are passive and active therapy.

Passive Physical Therapy

Passive physical therapy involves the following types of procedures:

  • Hot and cold therapy
  • Massage therapy
  • Ultrasound
  • Electrotherapy
  • Passive range of motion

Hot and cold therapy involves the use of heating pads, hot packs, gel packs, hydrotherapy (e.g., water-based), and even ice cubes wrapped in a towel. Applying a cold pack lessens swelling, inflammation, pain, and muscle spasms by slowing down the circulation. Conversely, heat packs help boost blood flow toward the affected area. Increased blood flow delivers nutrients and oxygen to irritated tissue, while removing toxic waste. The warmth also relaxes tense muscles, reduces pain, and heightens flexibility. The application of cold packs, cooling gel pads, etc., typically lasts longer than heat applications, but both types of therapy may be alternated depending on the injury or an individual’s preference.

For massage therapy, a therapist uses their hands or specialized tools to stroke, knead, and rub the muscles. Lotion may also be applied to the skin’s surface to reduce friction. This highly popular form of therapy helps relieve spasms, muscle tension, inflammation, stiffness, and pain.   

An ultrasound entails applying a gel to the inflamed area, followed by the use of a special device that delivers soundwaves deep into the muscle tissue. This procedure creates warm sensations that loosen muscles and reduce pain.

Electrotherapy is a form of electrical stimulation that administers mild electric current to the affected areas. There are several types that are used for different therapeutic procedures. This includes stimulating muscle contractions, altering pain signal transmission, enhancing tissue healing, and administering pain medication through the skin. The most commonly used form is called transcutaneous electrical nerve stimulation (TENS). This procedure sends electrical pulses to nerves directly below the skin to lessen pain sensations, thereby making the discomfort more tolerable.

For the purpose of passive range of motion therapy, a physical therapist or machine stretches and moves certain sections of the body. This means that the individual is not actively moving (contracting) the muscles. Instead, the therapist or special machine performs assistive techniques that help increase range of motion in the affected regions of the lower back. The goal of this procedure is to restore mobility to the pre-injury state. However, a physical therapist needs to initially measure an individual’s range of motion to assess the degree of mobility impairment before starting this form of therapy.

There are additional types of passive physical therapy, but the described procedures are the most popular due to their efficacy.

Active Physical Therapy

Active physical therapy techniques include:

  • Aerobic conditioning
  • Active range of motion (e.g., self-stretching, strength training)
  • General rehabilitation exercises (e.g., therapeutic movements)

For the active portion of the treatment, a therapist demonstrates techniques that improve muscle strength and flexibility. Performing strenuous exercises in an improper manner can put excessive stress on the spine. However, active therapies are not meant to push individuals beyond their limits. The therapist demonstrates gentle exercises that help condition the body’s core (e.g., abdominal muscles) and spine.  

Active exercise is usually emphasized for a physical therapy program that aims at treating lower back pain, although both forms may afford the most benefits. For instance, a heating pad may be used to administer heat that relaxes the muscles before the active portions of the therapy, including stretching and exercising begins. Similarly, an ice pack may be placed on the lower back following the active part of the session to sooth back muscles and soft tissue. The therapist will be able to gauge when each therapeutic approach should be utilized.  

Lower Back Pain and Sciatica

A serious injury, accident, or even degenerative disease may cause lower back pain, but the symptoms may also develop due to sciatica. This condition refers to debilitating nerve pain in the lower back that may extend down the legs. The symptoms include:

  • Hip pain
  • Piercing lower back pain
  • Pain in one or both of the legs
  • Tingling, numbness, or weakness in the legs, feet, buttocks, or thighs

Conditions such as nerve root compression as well as a degenerated or herniated disc may lead to sciatica. If the discomfort is not properly addressed, it can dramatically reduce physical activity. However, physical therapy promotes stronger muscles that offer improved defense against pain. The use of passive therapies such as an ultrasound or TENS may be particularly useful toward improving sciatica by altering pain signal transmission and enhancing the body’s production of endorphins, which are natural pain-relieving compounds.

Furthermore, the therapist will incorporate active therapy (e.g., low-impact exercises) with postural alignment techniques as well as ergonomic strategies that help protect the spine. By implementing these changes into the daily routine, future episodes of sciatica may be prevented. Overall, the combination of both therapeutic forms reduces lower back pain by targeting nerve irritation in the lower back, core, and the legs.

What to Expect at Physical Therapy For Lower Back Pain

During the first appointment, the physical therapist usually reviews an individual’s medical history, daily routine, activity level, and lifestyle habits (e.g., diet, smoking, etc.). Information regarding previous experiences with lower back pain will be gathered as well. A therapist will also want to know if a specific injury or traumatic event (e.g., fall, car accident) triggered the symptoms as well as if the lower back pain is significantly reducing mobility.

Next, the physical therapist will request that a series of simple movements be performed to assess posture, reflexes, movement ability, and range of motion. This may include moving from side-to side, bending forward, twisting at the waist, or reaching backward. Body positioning while walking will be observed as well. This part of the assessment provides the therapist with a comprehensive overview of an individuals’ current physical status and how the lower back pain may be affecting the ability to carry out daily activities.

This information is then used to develop a personalized program that generally includes both active and passive techniques. As progress is made and the lower back pain begins to subside, the therapeutic regimen may be gradually adjusted to incorporate additional exercises or stretches. Just as with most other treatment approaches, it takes time to experience improvement and several weeks may pass before desired outcomes are observed. It is important to stick with the regimen and to continue performing any at-home exercises that are recommended to promote recovery from lower back pain and sciatic.

Physical Therapy Exercises for Lower Back Pain

Most lower back pain episodes resolve on their own, but active exercise efficiently targets persistent pain that reduces range of motion. An ongoing therapeutic routine also decreases the severity and likelihood of future incidences of lower back pain. A physical therapist may suggest a combination of manual, physical, or soft tissue mobilization (myofascial release) along with exercise therapies to treat lower back pain or sciatica. The types of exercises that will be recommended depend on the underlying cause of the pain as well as the individual’s level of overall conditioning, but may include:

  • Gait training
  • Functional retraining
  • Active assisted range of motion
  • Supine core strengthening
  • Extension and flexion back exercises
  • Strengthening exercises (e.g., isometric or isotonic exercise)
  • Mechanical diagnosis and therapy (MDT) or the McKenzie Method

These approaches may be combined with manual techniques such as joint manipulation, dry needling, muscle energy technique, mechanical traction, TENS, or a similar form of electrical stimulation called neuromuscular electric muscle stimulation. The carefully demonstrated exercises help relieve lower back and lumbar pain. They also support enhanced health and fitness, which helps reduce the incidence of recurring back pain or sciatica. By relieving tension in rigid muscles and strengthening weak muscle tissue, proper balance and long-term wellness can be restored in the body.

Does Physical Therapy Hurt?

Physical therapy should not be painful, but as it involves parts of the body that are injured, inflamed, or causing chronic pain, the treatment procedure may cause slight discomfort. The body may also be sore after a deep tissue massage or stretching exercise. This is because mobilizing, strengthening, and stretching the affected area necessitates specific movements along with physical manipulation that causes soreness after a session.

Furthermore, muscles or ligaments that may have become weak and rigid over time require specialized exercises that cause lactic acid to build up. When this happens, minor irritation may develop in the area. However, soreness should not feel like pain. If excessive discomfort is experienced or severe pain develops after a session, this should be discussed with the physical therapist who can modify the treatment accordingly. A therapist may also use a hot-cold application following the procedure to help reduce soreness.

Another key factor to consider is that each individual is different. Thusly, people’s pain thresholds vary widely. This means that communication is important as intense pain during therapy may indicate that there is a more serious underlying problem. Additionally, physical therapists are specifically trained to notice when a certain technique or exercise is causing unnecessary discomfort and they can quickly adjust the regimen to lessen the pain.

Overall, minor discomfort in the lower back that may be experienced during physical therapy is a necessary part of the natural healing process. Accordingly, it is important to remember that as more time and effort is put into the regimen, the body should gradually begin to recover. The discomfort should consistently decrease as well. The stretching and strengthening exercises help relieve tension in injured muscle tissue, but it also encourages the body to rebuild stronger tissue. Therefore, adhering to the treatment regimen even if the sessions become uncomfortable is the key to experiencing improved function and mobility.


Physical therapy for lower back pain supports mobility, strength, and an enhanced quality of life. The stability of the spinal bones and discs in the lower back, is largely dependent upon the supporting muscles in the abdomen as well as the trunk of the body. More specifically, abdominal muscles generate physical pressure in the abdominal region that is simultaneously exerted on the anterior (front) and posterior (back) area of the spine. Muscles located in the lower back function in a similar manner.

Accordingly, strengthening these particular muscles through physical therapy reduces the risk of reinjuring the spinal bones or discs in the spine. Adhering to the physical therapy regimen also helps individuals build a strong, thick belt of muscle tissue around the spine to lower the incidence of future back pain. After completing therapy, individuals who continue to incorporate the therapeutic exercises and maintenance strategies into a daily routine usually experience long-term improvement of lower back pain.

FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!

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