Low Back Pain
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| UW Health Spine Clinic physical therapist Julie Sherry, PT, MS |
What is low back pain?
Low back pain is very common in athletic and non-athletic populations, and is a common cause of disability. Low back pain is the most common type of pain reported by adults. Despite advances in diagnostic imaging and surgical technology, often times it is difficult to identify the cause of low back pain.
Low Back Pain Treatment
The most effective treatment involves a classification system that identifies clusters of signs and symptoms that predict a more favorable outcome with a specific treatment approach.
After screening patients for any serious problems, information collected during the history and physical examination is used identify the best treatment approach for each individual patient.
Examples of Treatment Approaches
| Approach | Exam Findings | Treatment |
| Joint Mobilization and Manipulation |
No sciatic pain radiating below the knee Pain flare-up less than 16 days duration Stiffness in the low back Excessive hip rotation turning in |
Mobilization and/or manipulation of the low back and pelvis Active range of motion exercises |
| Specific Exercise: Flexion |
Older age (typically greater than 50 years old) Less pain in legs with forward bending Diagnosis of lumbar spine stenosis |
Knee to chest (Williams) flexion exercises Mobilization/manipulation of the spine and lower extremities Individualized exercises to promote strength and flexibility Body weight supported walking (on a specialized treadmill or chest depth in a pool) |
| Specific Exercise: Extension |
Pain radiating from low back past the buttock Less pain in the legs with back bending Worse pain with forward bending |
Backward bending (McKenzie) extension exercises Joint mobilization to promote backward bending Avoidance of flexion activities |
| Stabilization Exercise |
Younger age (typically less than 40 years old) Above average flexibility of hamstrings Painful/difficulty with bending and rising up from forward bending Less pain with back muscle contractions |
Individualized prescription of abdominal stabilization and strengthening exercises Flexibility exercises for pelvic musculature |
| Traction |
Pain radiating from low back past the buttock Signs of nerve root compression (numbness or weakness in leg, loss of knee or ankle reflex) Less leg pain with back bending Low back pain during hamstring flexibility testing |
Prone mechanical traction, back bending (extension) exercises |
Bibliography
- Fritz JM, A Delitto, RE Erhard. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain. Spine. 2003;28(13):1363-1372.
- Fritz J, JA Cleland and JD Childs. Subgrouping patients with low back pain: evoluation of a classification approach to Physical Therapy. JOSPT. 2007;37(6):290-301.
