Low Back Pain: One Size Does Not Fit All

Low Back Pain: One Size Does Not Fit All

June 4, 2024

Low back pain is a very common complaint, as up to 80% of adults are estimated to experience low back pain at some point in their lives. 

Physical therapy has been proven to be an effective conservative treatment approach for low back pain. Physical therapists (PTs) treat low back pain with a variety of methods. No two patients with low back pain are exactly alike, which is why a cookie cutter treatment approach is not appropriate for patients with low back pain. 

Low back pain can derive from multiple factors and impairments, and tends to present in a way that is very unique to each individual. Here are some things that your PT should be looking at to determine the root cause of your low back pain and to figure out the best treatment plan for you. 

  • Posture: By looking at a patient’s posture in different positions (sitting, standing, work set up), your PT can educate you on adjustments that can be made to minimize the stress placed on the low back. Poor posture not only puts extra stress on some muscles, but can also weaken the muscles of the back over time. Making a few simple corrections can help to reduce pain in the short term and prevent a recurrence of pain in the long term.

  • Surrounding joints: Your PT should be looking at lower body function down to the foot. Problems at the foot, ankle, knee, or hip can actually contribute to low back pain, so it is a good idea to assess strength, stability, and range of motion of the joints below the low back. A common issue is tightness in the hips contributing to low back pain. PTs should also be examining the mid and upper back, as issues in those areas can affect the low back as well.

  • Low back range of motion: Looking at the range of motion and movement patterns of the low back can help guide treatment. Some patients prefer activities in a more flexed (bent forward) position, while others prefer a more extended (upright) position. Figuring this out can help your PT find exercises that help alleviate pain initially, and give them a better idea of your limitations and long term goals for activities. Some patients have specific joints or muscles that are stiff and that elicit their pain. Some patients are very tight and stiff moving in certain directions at the spine. All of this gives your PT helpful information to not only determine a PT diagnosis, but also to guide a specific course of treatment. 

  • Lifting and/or job body mechanics (i.e. ergonomic assessment) – PTs are trained to observe the way you move and make sure you are moving in a way that optimizes strength and reduces risk of pain or injury. They can assess your movement patterns when you lift, carry, and perform work tasks, for example, and educate you on any corrections that need to be made.

  • Core strength: Core strength is very important in the management of low back pain. PTs can assess your core strength and prescribe appropriate exercises that will not flare up your symptoms, and then progress the activities as you get stronger. 

While not all patients may require all of these specific treatment options, it is important for a PT to assess these areas to know how to design your unique treatment plan. PTs should choose treatment interventions based on personal experience, the latest research, the specific presentation of the patient, and patient values.

You are a unique individual; make sure you are receiving the unique and personalized care that you deserve!