Lower back pain is a common problem that affects many people at some point in their lives. While most episodes of acute lower back pain resolve on their own within a few weeks, chronic or recurrent back pain can significantly impact quality of life. Physiotherapy aims to treat and prevent lower back pain through a variety of exercises and manual therapy techniques. This article outlines some effective physiotherapy exercises that can help provide relief from lower back pain.
Causes of lower back pain
There are several possible reasons why someone might experience lower back pain, including:
Muscle strains or pulls
The muscles, ligaments and tendons around the lower back can be strained or pulled due to overuse, poor posture or improper lifting. Activities that apply stress to the lower back like heavy lifting or repetitive bending/twisting movements put stress on these soft tissues and increase injury risk.
Weak back muscles
Having weak back and core muscles makes the lower back susceptible to injury. Weak abdominal, back and buttock muscles cannot adequately support the spine during activities. This transfers stress to the low back structures instead of evenly distributing forces.
Poor posture
Spending long periods of time sitting without good lumbar support allows the back muscles to weaken over time. Also, slouching while sitting or standing puts the spine in an unnatural position that strains tissues.
Arthritis
Conditions like osteoarthritis or degenerative disc disease involve the breakdown of joints and discs in the spine over time. This wear and tear leads to inflammation and compression of spinal nerves resulting in back pain.
Injuries
Traumatic injuries to the lower back such as herniated discs can occur due to an accident, fall or sudden heavy lifting mishap applying too much pressure on the spine.
Other causes
Other possible but less common causes include osteoporosis, spondylolisthesis, spinal stenosis, tumors and infections. In many cases, the exact underlying cause cannot be definitively determined.
Physiotherapy treatment goals
The primary goals of physiotherapy for lower back pain are to:
Reduce pain and inflammation
Through techniques like ice, heat, massage and electrical stimulation therapies, physiotherapists help alleviate pain and diminish inflammation in irritated tissues.
Improve posture and movement patterns
Evaluating posture and the way someone moves allows physiotherapists to identify dysfunctional patterns and areas of weakness. Exercises are then prescribed to correct imbalances and reinforce healthy movements.
Strengthen core and back muscles
Targeted low-impact strengthening exercises build endurance in the abdominal, back and gluteal muscles to provide more adequate support to the spine. Stronger muscles also help protect against future injury.
Improve flexibility
Stretches can help lengthen tight or shortened muscles that put increased strain on the lower back. Greater flexibility also enhances the range of motion needed for daily activities.
Educate on proper body mechanics
Patients learn about body positions and motions that minimize stress on the back during common movements like lifting, bending, sitting and standing. This carries over to preventing future episodes.
Manage symptoms and improve function
The overall goal is to get patients back to their normal activities and routines with minimal or no back pain. Physiotherapy aims to do this through a graduated active recovery program.
Common physiotherapy exercises
Specific lower back exercises prescribed by a physiotherapist will depend on the individual’s condition and abilities. Some general types of lower back exercises used in physiotherapy include:
Pelvic tilts
Laying on your back with knees bent, tilt your pelvis up and down by tightening and relaxing your abdominal muscles. This isolates the back extensor muscles.
Bridging
Lay on your back with knees bent, lift your hips up towards the ceiling. Squeeze your glutes and hamstrings. Later progress to single leg bridging.
Prone lies
Lay face down and relax your lower back muscles. This allows tissues to reduce inflammation through the relaxation response.
Cat/cow stretches
Get on your hands and knees, arch your back like a cat then round it like a cow in a smooth flowing motion. Stretches the spine.
Low back rotations
Sit tall with feet flat, slowly rotate your upper body to each side without twisting at the hips. Gently stretches muscles.
Planks
Hold yourself up with elbows and toes in a straight line from head to heels. Engages the deep core muscles around the lower back.
Bird-dog
On all fours, extend one arm forward and opposite leg back keeping a straight alignment. Challenges stability.
Back extensions
Lay facedown supported by forearms, lift chest and hips off the floor by squeezing glutes and hamstrings. Strengthens lower back.
Side-lying leg lifts
Lie on your side and lift the top leg up and down without rotating your pelvis. Works the back muscles isometrically while isolating the legs.
Along with manual therapy techniques like massage, manipulation and mobilizations, a physiotherapist utilizes these evidence-based exercises progressively over treatment sessions to achieve functional and pain-free outcomes. Consistency with a home exercise program is key to long-term relief from back problems.
Additional therapeutic modalities
Depending on the patient’s needs, physiotherapists may incorporate additional treatment modalities and modalities into a lower back program including:
Transcutaneous electrical nerve stimulation (TENS)
The TENS machine uses mild electric pulses on surface electrodes placed on the skin over the painful area. This can help gate pain signals to the brain.
Therapeutic ultrasound
High-frequency sound waves from the ultrasound unit are applied over tissues to promote healing of inflamed or injured structures through increased blood flow.
Therapeutic heat/cold therapies
Application of heating pads, ice packs or thermal therapy wraps constricts or dilates blood vessels to reduce pain and inflammation in the back tissues.
Traction
Low-load distraction techniques like lumbar rolling or lumbar mechanical traction are used to gently separate vertebrae and reduce pressure/irritation on spinal discs and nerves.
Postural taping or bracing
Kinesiology taping or lumbar support bracing may be used for persons with significant muscle imbalance issues or spinal instability to correct alignment during activities of daily living.
While exercise remains key to resolving back problems long-term, physiotherapists integrate modalities judiciously as needed in rehabilitation plans to maximize benefits for individual clients. An active recovery approach involving both modalities and exercises usually yields the best outcomes with lower back pain.
When to consult a physiotherapist
It’s generally a good idea to seek physiotherapy if lower back pain:
Persists for more than 2-4 weeks despite attempts at self-care
This suggests underlying mechanical issues or dysfunction needing hands-on treatment.
Is accompanied by signs of nerve root involvement
Symptoms like radiating leg pain, numbness/tingling, or weakness indicate the need for evaluation by a specialist.
Returns frequently or gets progressively worse
Recurrent/worsening symptoms may indicate an untreated underlying problem that needs manual therapy and exercise interventions.
Impacts normal activities and quality of life
Back pain interfering significantly with work or daily duties signals that active rehabilitation is required rather than passive treatments alone.
Results from an acute injury
Traumatic back injuries need skilled physiotherapy evaluation and management to prevent long-term complications.
While self-care measures and over-the-counter medications are reasonable initial approaches, seeing a physiotherapist sooner rather than later allows for thorough assessment, targeted treatment and the best opportunity for a good outcome with lower back problems.
Conclusion
In summary, lower back pain is a widespread condition that may stem from injury, poor lifestyle habits or underlying anatomical issues. Physiotherapy utilizes tailored exercises, manual therapy and physical modalities in a graduated rehabilitation program to alleviate back pain, improve function and prevent recurrences long-term. Regular lower back exercises like pelvic tilts, bridges and planks, combined with hands-on care from a physiotherapist, represent an evidence-based approach for resolving both acute and chronic lower back conditions. Seeking physiotherapy helps address potential mechanical causes and ensure long-lasting relief from painful lower back symptoms.