Physical Therapy in Venice for Lower Back

Welcome to FYZICAL Venice's patient resource about low back pain.

Low back pain is one of the main reasons people visit their doctor. For adults over 40, it ranks third as a cause for doctor visits, after heart disease and arthritis.

Eighty percent of people will have low back pain at some point in their lives. And nearly everyone who has low back pain once will have it again.

Very few people who feel pain in their low back have a serious medical problem. Ninety percent of people who experience low back pain for the first time get better in two to six weeks. Only rarely do people with low back pain develop chronic back problems.

With these facts in mind, you can be assured that back pain is common, that it usually only causes problems for a short period of time, and that you can take steps to ease symptoms and prevent future problems.

This guide will help you understand:

• which parts make up the spine and low back
• what causes low back pain, and what the most common symptoms are
• what tests your doctor may run
• how to manage your pain and prevent future problems

Which parts make up the lumbar spine, and how do they work?

The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body's main upright support.

From the side, the spine forms three curves. The neck, called the cervical spine, curves slightly inward. The mid back, or thoracic spine, curves outward. The outward curve of the thoracic spine is called kyphosis. The low back, also called the lumbar spine, curves slightly inward. An inward curve of the spine is called lordosis.

The lumbar spine is made up of the lower five vertebrae. Doctors often refer to these vertebrae as L1 to L5. The lowest vertebra of the lumbar spine, L5, connects to the top of the sacrum, a triangular bone at the base of the spine that fits between the two pelvic bones. Some people have an extra, or sixth, lumbar vertebra. This condition doesn't usually cause any particular problems.

Each vertebra is formed by a round block of bone, called a vertebral body. The lumbar vertebral bodies are taller and bulkier compared to the rest of the spine. This is partly because the low back has to withstand pressure from body weight and from daily actions like lifting, carrying, and twisting. Also, large and powerful muscles attaching on or near the lumbar spine place extra force on the lumbar vertebral bodies.

A bony ring attaches to the back of each vertebral body. When the vertebrae are stacked on top of each other, these rings form a hollow tube. This bony tube surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.

The spinal cord extends down to the L2 vertebra. Below this level, the spinal canal encloses a bundle of nerves that goes to the lower limbs and pelvic organs. The Latin term for this bundle of nerves is cauda equina, meaning horse's tail.

As the spinal cord travels from the brain down through the spine, it sends out nerves on the sides of each vertebra called nerve roots. These nerve roots join together to form the nerves that travel throughout the body and form the body's electrical system. The nerve roots that come out of the lumbar spine form the nerves that go to the lower limbs and pelvis. The thoracic spine nerves go to the abdomen and chest. The nerves coming out of the cervical spine go to the neck, shoulders, arms, and hands.

It is sometimes easier to understand what happens in the spine by looking at a spinal segment. A spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal cord at that level, and the small facet joints that link each level of the spinal column.

The intervertebral disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during heavy activities that put strong force on the spine, such as jumping, running, and lifting.

An intervertebral disc is made up of two parts. The center, called the nucleus, is spongy. It provides most of the disc's ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are strong connective tissues that attach bones to other bones.

Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of movement as you bend forward and back.

The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It allows the bone ends to move against each other smoothly, without pain.

Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right. As the nerves leave the spinal cord, they pass through a small bony tunnel on each side of the vertebra, called a neural foramen. (The term used to describe more than one opening is neural foramina.)

The lumbar spine is supported by ligaments and muscles. The ligaments are arranged in various layers and run in multiple directions. Thick ligaments connect the bones of the lumbar spine to the sacrum (the bone below L5) and pelvis.

The muscles of the low back are also arranged in layers. Those closest to the surface are covered by a thick tissue called fascia.

The middle layer, called the erector spinae, has strap-shaped muscles that run up and down over the lower ribs, chest, and low back. They blend in the lumbar spine to form a thick tendon that binds the bones of the low back, pelvis, and sacrum.

The deepest layer of muscles connects along the back surface of the spine bones. The muscles also connect the low back, pelvis, and sacrum. These deepest muscles coordinate their actions with the muscles of the abdomen to help hold the spine steady during activity.

Why do I have low back pain?

There are many causes of low back pain. Doctors are not always able to pinpoint the source of a patient's pain. But your doctor will make every effort to ensure that your symptoms are not from a serious medical cause, such as cancer or a spinal infection.

The vast majority of back problems are a result of wear and tear on the parts of the spine over many years. This process is called degeneration. Over time, the normal process of aging can result in degenerative changes in all parts of the spine.

Injuries to the spine, such as a fracture or injury to the disc, can make the changes happen even faster. There is strong evidence that cigarette smoking also speeds up degeneration of the spine. Scientists have found links among family members, showing that genetics plays a role in how fast these changes occur.

The intervertebral disc changes over time. At first, the disc is spongy and firm. The nucleus in the center of the disc contains a great deal of water. This gives the disc its ability to absorb shock and protect the spine from heavy and repeated forces.

The first change that occurs is that the annulus around the nucleus weakens and begins to develop small cracks and tears. The body tries to heal the cracks with scar tissue. But scar tissue is not as strong as the tissue it replaces. The torn annulus can be a source of pain for two reasons. First, there are pain sensors in the outer rim of the annulus. They signal a painful response when the tear reaches the outer edge of the annulus. Second, like injuries to other tissues in the body, a tear in the annulus can cause pain due to inflammation.

With time, the disc begins to lose water, causing it to lose some of its fullness and height. As a result, the vertebrae begin to move closer together.

As the disc continues to degenerate, the space between the vertebrae shrinks. This compresses the facet joints along the back of the spinal column. As these joints are forced together, extra pressure builds on the articular cartilage on the surface of the facet joints. This extra pressure can damage the facet joints. Over time, this may lead to arthritis in the facet joints.

These degenerative changes in the disc, facet joints, and ligaments cause the spinal segment to become loose and unstable. The extra movement causes even more wear and tear on the spine. As a result, more and larger tears occur in the annulus.

The nucleus may push through the torn annulus and into the spinal canal. This is called a herniated or ruptured disc. The disc material that squeezes out can press against the spinal nerves. The disc also emits enzymes and chemicals that produce inflammation. The combination of pressure on the nerves and inflammation caused by the chemicals released from the disc cause pain.

As the degeneration continues, bone spurs develop around the facet joints and around the disc. No one knows exactly why these bone spurs develop. Most doctors think that bone spurs are the body's attempt to stop the extra motion between the spinal segment. These bone spurs can cause problems by pressing on the nerves of the spine where they pass through the neural foramina. This pressure around the irritated nerve roots can cause pain, numbness, and weakness in the low back, buttocks, and lower limbs and feet.

A collapsed spinal segment eventually becomes stiff and immobile. Thickened ligaments and facet joints, scarred and dried disc tissue, and protruding bone spurs prevent normal movement. Typically, a stiff joint doesn't cause as much pain as one that slides around too much. So this stage of degeneration may actually lead to pain relief for some people.

View animation of degeneration

Mechanical and Neurogenic Pain

To best understand the cause of your pain, spine specialists sometimes divide low back pain into two categories:

•         mechanical pain
•         neurogenic pain

Mechanical Pain

Mechanical back pain is caused by wear and tear in the parts of the lumbar spine. This type of pain is similar in nature to a machine that begins to wear out. Mechanical pain usually starts from degenerative changes in the disc. As the disc begins to collapse and the space between the vertebrae narrows, the facet joints may become inflamed. Mechanical pain typically gets worse after activity due to strain on the moving parts of the spine. Mechanical pain is usually felt in the back, but it may spread into the buttocks, hips, and thighs. The pain rarely goes down past the knee. Mechanical back pain usually doesn't cause weakness or numbness in the leg or foot, because the problem is not from pressure on the spinal nerves.

Neurogenic Pain

Neurogenic pain means pain from nerve injury. Neurogenic pain occurs when spinal nerves are inflamed, squeezed, or pinched. This can happen when a disc herniates or when a nerve gets pinched where it leaves the spine. Recently it has also become known that when a disc ruptures, chemicals are released that inflame the nerves even if there is no pressure directly on the nerve. Neurogenic symptoms concern doctors more than mechanical pain because they can signal damage to the nerves and lead to weakness or numbness in the lower extremities.

The nerve pressure causes symptoms in the areas where the nerve travels, rather than in the low back. This happens because pressure on the spinal nerve affects structures away from the spine, such as the muscles. As a result, a person's back may not hurt, yet the person feels pain, numbness, or weakness in the leg or foot. This indicates there's a problem with the body's electrical wiring. The pressure on the nerve affects how the body functions. Muscles weaken. Reflexes slow. Sensations of pins, needles, and numbness may be felt where the nerve travels.

The effects of spine degeneration or back injury can lead to specific spine conditions. These include:

•         annular tears
•         internal disc disruption
•         herniated disc
•         facet joint arthritis
•         segmental instability
•         spinal stenosis
•         foraminal stenosis

Diagnostic Tests

In a number of low back pain cases, no special diagnostic testing is required to diagnose and treat your back pain. Your doctor or Physical Therapist will be able to determine what the most probable cause of your pain is from the history of your injury, how you are moving, and from the physical exam. The exact structure causing the pain in your back may be unknown, but this does not preclude treatment to help your pain. A combination of irritated connective tissues, muscles, joints, ligaments, discs, and nerves in the back is often the culprit, so ‘diagnosing’ or naming one single structure is usually futile. Treatment to help your back problem can still be effective without knowing the exact anatomical cause of your pain.

When acute back pain occurs, diagnostic tests are not routine, as diagnostic tests that are completed unnecessarily may produce misleading findings. In numerous interesting studies, patients have demonstrated major structural changes in different back or spinal structures on x-rays in the absence of physical symptoms.

Diagnostic testing for back pain is reserved for cases where:

• The pain is not acting as your Physical Therapist or doctor would expect
• Your symptoms aren’t resolving with the usual conservative treatment
• Your pain is intense and relentless
• Your pain is affecting your normal functions
• Your symptoms include nerve pains in your leg and foot

You have a suspected serious problem, such as cauda equina syndrome, which refers to disc disruption that is affecting the nerves supplying your bowel and bladder

Radiological Imaging

If diagnostic tests are deemed necessary, there are several different tests that your doctor may recommend. Radiological imaging tests allow your doctor to see the anatomy of your spine, which assists the determination of what may be causing your back pain. Knowing what structures may be contributing to your back pain may help further direct the most appropriate treatment to assist you.

X-rays 

X-rays are usually the first test ordered before any of the more specialized tests are completed.  X-rays use electromagnetic radiation to show problems with bones and can also reveal problems such as fractures, infections, or bone tumors. X-rays of the spine can give your doctor information about bone alignment and can demonstrate how much degeneration has occurred in the spine. Both alignment and degeneration can affect the amount of space in the neural foramina and between the discs, which subsequently impacts the nerves in the area. This is important information your health care professional can use to establish a treatment plan.

Flexion and Extension X-rays 

Special x-rays called flexion and extension x-rays may help to determine if there is true instability between vertebrae. These x-rays are taken from the side as you bend as far forward and then as far backward as you can. Comparing the two x-rays allows the doctor to see how much motion occurs between each spinal segment.

Magnetic Resonance Imaging (MRI)

An MRI scan uses magnetic waves (not radiation) to create pictures of the lumbar spine in sections called slices. The MRI scan shows the bones in the lumbar spine as well as soft tissue structures such as the discs, joints, and nerves. MRI scans are painless and don’t subject you to radiation as an x-ray does. MRI scans are the most common test for visualizing the lumbar spine after an x-ray has been taken. These tests may be recommended if your health care provider is concerned that surgery may be necessary.

In some cases, specialized MRIs that involve an injection of contrast dye may be recommended by your doctor to see specific structures. These special MRIs are performed following the intravenous injection of gadolinium-based dye. The contrast dye enhances image quality and can define some structures more than a regular MRI.

Computed Tomography (CT) Scan 

A CT scan is a special type of x-ray that lets doctors see thin sections or slices of tissue. The machine uses a computer and a series of x-rays to create these slices. CT scans subject patients to significantly more electromagnetic radiation than a traditional x-ray, so this type of test will only be ordered when truly necessary to help diagnose a problem. CTs can be useful for the visualization of bones, soft tissues, and blood vessels.

Myelogram 

The myelogram is a special kind of x-ray or CT scan where a dye is injected directly into the spinal canal to look for problems in this area. Myelograms are used to help diagnose herniated discs, pressure on the spinal cord or spinal nerves, spinal tumor, or bone spurs that may be pressing on the spinal canal structures.

Discogram 

The discogram is another type of specialized x-ray. A discogram has two stages. First, a needle is inserted into the problem disc and then saline is injected to create pressure inside the disc. If this injection reproduces your pain, it suggests that the disc is the source of your problem. During the second part of the test, dye is injected into the disc. The dye can be seen on an x-ray. Using both regular x-rays and CT scan images, the dye outlines the inside of the disc. This can show abnormalities of the nucleus such as annular tears and ruptures of the disc.

Bone Scan 

A bone scan (skeletal scintigraphy) specifically diagnoses problems with your bones. During a bone scan, a safe and small amount of a radioactive tracer is injected into your veins. This tracer is taken up by your bones. The tracer illuminates on special diagnostic images taken of your back. The tracer builds up more in areas where bone is undergoing a rapid repair process, such as a healing fracture or the area surrounding an infection or tumor. A bone scan may initially be used to locate a problem, then additional tests such as a CT scan or MRI can be used to look at the area in more detail.

Electromyogram (EMG) 

An EMG is a special test used to determine if there are problems with any of the nerves traveling from the spinal cord to the lower limbs. EMGs are usually performed to determine whether the nerve roots have been pinched by a herniated disc or structurally damaged by inflammation. During the test, small needles are placed into certain muscles that are supplied by each nerve root. If there has been a change in the function of the nerve, the muscle will not fire properly and this discrepancy will be noted. Furthermore, an EMG can help determine which nerve root is involved. Often, the nerve disruption has to be significant to show a change on an EMG.

Additional Tests

Not all causes of low back pain are from conditions within the spine itself. Other conditions, such as rheumatoid arthritis, spondyloarthropathies, or an infection may lead to a back problem. Pain may also be referred from issues such as gastrointestinal distress, stomach ulcers, kidney problems, and aneurysms of the aorta. Blood tests, urinalysis, or additional tests may be needed to rule out problems that do not involve the spine.

In certain low back pain cases that don’t respond to Physical Therapy, more aggressive forms of treatment may be required in addition to your active mobility and strengthening program. These are temporary measures and interventions designed to provide short-term relief that allows you to move more and build up your conditioning as well as load tolerance.

Injection-Based Treatments 

Spinal injections are used for both diagnostic purposes as well as treatment. There are several different types of spinal injections that your doctor may recommend. Most injections use a mixture of an anesthetic and some type of cortisone (anti-inflammatory) preparation. The anesthetic is a medication that numbs the area where it is injected. If the injection takes away your pain immediately, this provides important information suggesting that the injected area is indeed the source of your pain. The cortisone component in the injection decreases inflammation and can reduce the pain from an inflamed nerve or joint for a prolonged period of time.

Some injections are more difficult to perform and require the use of a fluoroscope. A fluoroscope is a special type of x-ray that allows the doctor to see a real-time x-ray image continuously on a TV screen during the procedure. The fluoroscope is used to guide the needle into the correct place before an injection is administered.

Epidural Steroid Injection (ESI) 

Back pain from inflamed nerve roots and facet joints may benefit from an ESI. During this procedure, the medication mixture is injected under fluoroscopy into the epidural space around the nerve roots. Generally, an ESI is only administered when other non-operative treatments aren't working. ESIs are unfortunately not always successful in relieving pain. If they do work, they may only provide temporary relief.

Selective Nerve Root Injection 

This type of injection places steroid medication around a specific inflamed nerve root. A fluoroscope is used to guide a needle directly to the affected spinal nerve root, which is then bathed with the medication. In difficult cases, the selective nerve root injection can also help surgeons decide which nerve root is causing the problem before surgery is planned.

Facet Joint Injection 

If facet joint inflammation or injury is the suspected cause of the low back pain, an injection into one or more facet joints can help ease pain and more specifically determine which joints are causing the problem.

During this procedure, a fluoroscope is used to guide a needle directly into the facet joint. The facet joint is then filled with a medication mixture. If the injection immediately eases the pain, it helps confirm that the facet joint is a source of pain. The steroid medication will reduce the inflammation in the joint over a period of days and may reduce or eliminate your back pain.

Trigger Point Injections 

Injections of anesthetic medications mixed with cortisone are sometimes administered directly into the painful points of muscles, ligaments, or other soft tissues near the spine. These injections can help relieve back pain, muscle spasms, and tender points in the back muscles.

Prolotherapy 

Injections of a dextrose-based solution into joints that are moving too freely can be used to stimulate temporary, low-grade local inflammation at the problem area. This initiates a subsequent healing cascade and scarring at the joint, which appears to ‘tighten’ tissue in the affected area. Prolotherapy is not generally performed under fluoroscopy.

Symptoms from low back problems vary. They depend on a person's condition and which structures are affected. Some of the more common symptoms of low back problems are:

•         low back pain
•         pain spreading into the buttocks and thighs
•         pain radiating from the buttock to the foot
•         back stiffness and reduced range of motion
•         muscle weakness in the hip, thigh, leg, or foot
•         sensory changes (numbness, prickling, or tingling) in the leg, foot, or toes

Rarely, symptoms involve changes in bowel or bladder function. A large disc herniation that pushes straight back into the spinal canal can put pressure on the nerves that go to the bowels and bladder. The pressure may cause symptoms of low back pain, pain running down the back of both legs, and numbness or tingling between the legs in the area you would contact if you were seated on a saddle. The pressure on the nerves can cause a loss of control in the bowels or bladder.

This is an emergency.

If the pressure isn't relieved, it can lead to permanent paralysis of the bowels and bladder. This condition is called cauda equina syndrome. Doctors recommend immediate surgery to remove pressure from the nerves.

Surgery for low back pain is, in most cases, a last resort for treatment, except in the case of cauda equina. Surgeons generally prefer that patients try nonsurgical treatments for a minimum of three months before considering surgery. Fortunately, most people with back pain gradually get better with Physical Therapy. Even people who have degenerative spinal changes tend to gradually improve with time. Only 1-3% of patients with degenerative lumbar conditions typically require surgery. In some stubborn cases of severe back pain that are not improving with Physical Therapy, surgery may be recommended.

In some rare cases, your doctor may need to perform immediate surgery if you are losing control of your bowels and bladder (cauda equina syndrome) or if your muscles are rapidly becoming weaker. If these conditions develop, surgery is imminently required to remove pressure from specific nerves in your lower back before they become permanently damaged.

There are many different operations that are performed for back pain. The goal of nearly all spine operations is to remove pressure from the nerves of the spine, stop excessive motion between two or more vertebrae, or both. The type of surgery performed depends on each patient's conditions and symptoms.

Laminectomy 

The lamina is part of the bony ring of the spinal canal. It forms a roof-like structure over the back of the spinal column. When the nerves in the spinal canal are being squeezed by a herniated disc or from bone spurs pushing into the canal, a laminectomy removes part or all of the lamina to release pressure on the spinal nerves. This is sometimes called a posterior decompression surgery.

Discectomy

When the intervertebral disc has ruptured, the portion that has ruptured into the spinal canal may acutely irritate or compress the nerve roots. This may cause pain, weakness, and numbness that radiates into one or both legs. The operation to remove the portion of the disc that is pressing on the nerve roots is called a discectomy or microdiscectomy. This operation is performed through an incision in the low back immediately over the disc that has ruptured and is one of the most common types of surgeries used to alleviate back pain.

In the past, spinal surgery required a large incision down the affected portion of the spine. Fortunately, spine surgeons can now perform most discectomy procedures through very small incisions in the low back. These surgeries are called minimally invasive surgeries. The obvious advantage of these minimally invasive procedures is there is less damage to the muscles of the back and thus a quicker recovery. Many surgeons are now performing minimally invasive discectomies as an outpatient procedure where no hospital stay is required.

Lumbar Fusion

When there is extra movement between two or more vertebrae, the excess motion can cause pain due to the motion itself as well as irritation of the nerves of the lumbar spine. In these cases, if Physical Therapy has not helped, a spinal fusion is usually recommended. The goal of a spinal fusion is to force two or more vertebrae to grow together, or fuse, into one bone. A solid fusion between two vertebrae stops the movement between the two bones and pain is reduced because the fusion stops movement and decreases the irritation of the nerve roots. There are many different types of spinal fusions performed.

In the past, the traditional operation to perform a fusion of the lumbar spine involved a procedure in which surgeons ‘decorticated’ the back surface of the vertebrae. Decorticate means to remove the hard outside covering of a bone to create a bleeding bone surface. Once this was performed, a bone graft was taken from the pelvis and laid on top of the decorticated vertebrae. Just like a bone fracture would naturally heal, the bone graft and the bleeding bone grow together and fuse to create one solid bone.

Unfortunately, spinal fusions in the past were not always successful, mainly because the vertebrae failed to fuse together in up to 20 percent of cases. Due to this common failure, surgeons began looking for ways to increase the success of fusions. Since metal plates and screws had been used to treat fractures of other bones for many years, surgeons explored the idea of using metal implants to help fuse spinal segments. The more firmly two bones can be held together while the healing phase occurs, the more likely the bones are to fully heal.

Major advances have been made in recent years in the development of metal rods, metal plates, and special screws that are designed to hold vertebrae together to aid spinal fusion. These new spinal fusion techniques are referred to as instrumented fusions because of the special devices used to secure the vertebrae to be fused. Today the most common type of fusion is performed using special screws called pedicle screws that are inserted into each vertebra and connected to either a metal plate or metal rod along the back of the spine. The vertebrae are still decorticated and the bone graft is still used to stimulate the fusion of bones as they heal. Metal cages are sometimes used to create space in the spine and hold vertebrae in place while natural bone healing and fusion occurs. Depending on the problem, surgeons may need to make a surgical incision in your back or they may need to perform the surgery from your abdominal area.

How will my health care provider find out what's causing my problem?

The diagnosis of low back problems begins with a thorough history of your condition. When you visit FYZICAL Venice we may ask you to fill out a questionnaire describing your back problems. Our Physical Therapist will ask you questions to find out when you first started having problems, what makes your symptoms worse or better, and how the symptoms affect your daily activity. Your answers will help guide the physical examination.

Your Physical Therapist will then physically examine the muscles and joints of your low back. It is important that we see how your back is aligned, how it moves, and exactly where it hurts.

Our Physical Therapist may do some simple tests to check the function of the nerves. These tests are used to measure the strength in your lower limbs, check your reflexes, and determine whether you have numbness in your legs or feet. The information from your medical history and physical examination will help us decide which further tests to run.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at FYZICAL Venice have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

FYZICAL Venice provides Physical Therapist services in Venice.

What can be done to relieve my symptoms?

Non-surgical Rehabilitation

Whenever possible, it is preferable to use treatments other than surgery. The first goal of these nonsurgical treatments is to ease your pain and other symptoms.

Bed Rest

In cases of severe pain, your Physical Therapist at FYZICAL Venice may suggest a short period of bed rest, usually no more than two days. Lying on your back can take pressure off sore discs and nerves. Our Physical Therapists usually advise against strict bed rest and prefer that patients do ordinary activities using pain to gauge how much is too much.

Back Brace

A back support belt is sometimes recommended when back pain first strikes. It can help provide support and lower the pressure inside a problem disc. FYZICAL Venice patients recovering from back pain are encouraged to gradually discontinue wearing the support belt over a period of two to four days. Otherwise, back muscles begin to rely on the belt and start to shrink (atrophy).

Medications

Ensure that you consult with your doctor or pharmacist regarding the use of pain relief or anti-inflammatory medication. Many different types of medications are typically prescribed to help gain control of the symptoms of low back pain. There is no medication that will cure low back pain. Medications are prescribed to help with sleep disturbances and to help control pain, inflammation, and muscle spasm.

Physical Therapy and Exercise

In addition to other nonsurgical treatments, patients with back pain often work with a Physical Therapist. Physical Therapy treatments focus on relieving pain, improving back movement, and fostering healthy posture. Our Physical Therapist can design a rehabilitation program to address a particular condition and to help you prevent future problems. There is a great deal of scientific evidence that exercise and increased overall fitness reduce the risk of developing back pain and can improve the symptoms of back pain once it begins.

Although the time required for rehabilitation varies among patients, you can expect to continue therapy for two to four months for chronic back problems. Our treatments are designed to ease pain and to improve your mobility, strength, posture, and function. Your Physical Therapist at FYZICAL Venice will also teach you how to control your symptoms and how to protect your spine for the years ahead.

At first, our Physical Therapist may apply various forms of treatment to address your symptoms. These are especially helpful in the early weeks to improve your comfort so you can get back to your normal activities. We’ll show you ways to position your spine for maximum comfort while you move, recline, or sleep. To help calm pain and muscle spasm, your Physical Therapist in Venice may apply heat or ice packs, electrical stimulation, and ultrasound.

If you have severe back pain, our Physical Therapist may work with you in a pool. Physical Therapy done in water puts less stress on your low back, and the buoyancy allows you to move easier during exercise.

You may be tempted to limit your activity because of your back pain. However, as a result of pain and inactivity, your muscles may become weak and deconditioned, and your back won't function optimally. Physical Therapists at FYZICAL Venice in Venice use active rehabilitation to prevent the harmful effects of deconditioning. With this active approach, you'll be shown how to lift and move safely. And you'll be shown how to strengthen your back muscles. In addition, aerobic exercises are used to improve your general fitness and endurance.

Aerobic exercises may include walking on a treadmill, riding a stationary bike, or swimming. These activities can relieve the stress of low back pain, and they can cause your body to release endorphins into the blood stream. Endorphins are your body's own natural painkillers.

An active approach to Physical Therapy can help you attain better muscle function, so you can get your activities done easier. Active rehabilitation speeds recovery, reducing the possibility that back pain will become a chronic problem. Activity helps you resume your normal lifestyle as swiftly as possible. Though you'll be cautioned about trying to do too much, too quickly, you'll be guided toward a return to your usual activities. This approach gives you a greater sense of control. You'll take an active role in learning how to care for your back pain. FYZICAL Venice treatment sessions focus on reassuring you that getting back to work and other normal activities swiftly won't cause you harm and can actually help you get better faster.

When needed, your Physical Therapist in Venice will encourage you to take certain actions to improve your spine health. For example, if you smoke, you'll be encouraged to get help to quit. Because of the limited blood supply in the tissues of the low back, smoking speeds the degenerative process and impairs healing. If you're out of shape, you'll be encouraged to get fit. This strategy makes it less likely that back pain or injury will strike again in the future.

Our Physical Therapist will show you how to keep your spine safe during routine activities. You'll learn about healthy posture and how posture relates to the future health of your spine. And you'll learn about body mechanics, how the body moves and functions during activity. Your FYZICAL Venice Physical Therapist will also teach safe body mechanics to help you protect your low back as you go about your day. This includes the use of safe positions and movements while lifting and carrying, standing and walking, and performing work duties.

As you recover, our Physical Therapist will gradually advance your treatment in a series of strengthening exercises for the abdominal and low back muscles. Working these core muscles can help you begin moving easier and lessens the chances of future pain and problems.

As our rehabilitation program evolves, you will progress with more challenging exercises. The goal is to safely advance your strength and function.

Your Physical Therapist will work closely with your doctor and employer to help you get back on the job as quickly as reasonably possible. You may be required to do lighter duties at first, but as soon as you are able, you'll begin doing your normal work activities. We can also do a work assessment to make sure you'll be safe to do your job. Our Physical Therapist may suggest changes that could help you work safely, with less chance of re-injuring your back.  

Post-surgical Rehabilitation

Rehabilitation after surgery is much more complex. Depending on what operation you've had, you may leave the hospital shortly after surgery. Some procedures, such as fusion surgery, require that you stay in the hospital for a few days.

During recovery from surgery, you should follow your surgeon's instructions about wearing a back brace or soft lumbar support belt. You should be cautious about overdoing activities in the first few weeks after surgery.

You may need Physical Therapy outside of the hospital. If you had a lumbar fusion, your surgeon may have you wait six weeks to three months before starting Physical Therapy. Although the time required for recovery varies, once you start Physical Therapy, you'll usually go for one to three months, depending on your progress and the type of surgery you had.

When you first visit FYZICAL Venice after surgery, our Physical Therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm. Pool therapy is often helpful after lumbar surgery.

We will use exercises are used to improve flexibility in your trunk and lower limbs. Strengthening for your abdominal and low back muscles is started. Our Physical Therapist will instruct you in safe ways to sleep, sit, lift, and carry. And you’ll be given ideas on how to do your work activities safely.

Ideally, you'll be able to go back to your previous activities. However, you may need to modify your activities to avoid future problems.

When treatment is well under way, regular visits to FYZICAL Venice will end. Although we will continue to be a resource, you'll be in charge of doing your exercises as part of an ongoing home program.

FYZICAL Venice provides services for Physical Therapy in Venice.