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Low Back Pain

UW Health Sports Medicine Athletic Trainer Julie Sherry
UW Health Spine Clinic physical therapist Julie Sherry, PT, MS
UW Health Orthopedics and Rehabilitation in Madison, Wisconsin provides comprehensive treatment for low back pain.
 

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  

  1. 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.
  2. 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.