Pain Relief with Physical Therapy and Exercise

Dear Spine-Health Member,

The use of some type of physical therapy and exercise is integral to almost all forms of back pain and neck pain treatment. Sometimes physical therapy and exercise are the first lines of treatment, other times it may help manage chronic pain, or provide rehabilitation after surgery. But did you know that both gentle back exercise and physical therapy play a vital role in relieving pain?

Physical therapy and exercise are perhaps the most mainstream of all non-surgical treatments for back pain and neck pain. And unlike other conservative treatments (medication, injections, etc.) physical therapy can also help prevent (and/or lessen) future recurrences of back pain or neck pain.

Please remember that it is always advisable to check with your physician prior to beginning any exercise program.

First, alleviate the acute pain before you begin to exercise

When you're in a lot of pain, the thought of active rehabilitation and exercise can be pretty daunting. For this reason, your physician and/or physical therapist will first focus on bringing your pain to a tolerable level, and may use one or a combination of the following passive pain-relieving techniques (modalities): Electrical stimulation (e.g. TENS units); Ice and/or heat; ultrasound; massage therapy.

Medications, injections, manual manipulation, or other treatments may also be needed to sufficiently reduce your pain. All of the above therapies are designed with one goal in mind: to provide enough pain relief to help you progress to an active exercise program.

See also Physical therapy: Passive PT (modalities) for back pain.

Carefully pace yourself

When returning to activity after an episode of pain or following surgery, you absolutely will want to pace yourself. The danger is getting in a pattern of beginning a day with minimal pain, and subsequently engaging in so many activities that you relapse with severe pain.

A much healthier approach to rehabilitation is to pace your activities regardless of how you are feeling in order to keep the pain under relatively good control and prevent a flare-up. See Rehabilitation and exercise for a healthy back.

Engage in active physical therapy (exercise)

Active exercise is necessary to help the back heal and stay healthy. While some of the muscles that provide support for the spine are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.

Any exercise program for the back should include a combination of stretching, strengthening, and low-impact aerobic exercise.

1. Stretching exercises are important because any form of inactivity - especially where an injured back or neck is involved - is usually associated with some progressive stiffness. These structures are designed to move, and any limitation in motion can accentuate your pain.

2. Strengthening exercises. Certain strengthening programs can help centralize the pain, which for many people is more tolerable, or help reduce motion at the injury location. For example:

3. • McKenzie exercises are designed to relieve sciatica (leg pain) by "centralizing" the pain. For most patients, back pain is more tolerable than leg pain, and centralizing the pain may help the patient continue with conservative treatment and avoid surgery.

   • Dynamic lumbar stabilization exercises control pain by reducing motion at the injury location. This technique involves training muscles to automatically provide protective support during activity.

4. Low-impact aerobic conditioning promotes healing by bringing blood flow to the injured area. Longer term, aerobic exercise reduces the likelihood and severity of any future episodes of back pain, and enables patients to better maintain their regular routine (work, hobbies, other activities).

5. • See How a physical therapist can help with exercise and Back exercise and physical therapy for back pain.

Consider water therapy

Exercises that would normally be too painful to do on land, such as walking, often become tolerable to do in the water. Not only does the water provide the therapeutic effect of relieving pain, it helps get you ready for more extensive exercise.

With immersion in neck-deep water, the effective load on the spine is only that of the head and neck, rather than the whole body. This can be important for people who are overweight, as the effect of buoyancy essentially negates the extra body weight, allowing the patient to move freely in the water. It is also quite effective for people with painful joint conditions, such as osteoarthritis.

Water also has other rehabilitative benefits. For example, immersion in water increases cardiac output and approximates low-impact aerobic activity.

See also Water therapy exercise program.

Expect some initial discomfort

However, the pain experienced when doing an appropriate exercise program for back pain should be "good pain". This pain is to be expected as a natural part of increasing activity - stretching tissues that have become stiff and using muscles in unfamiliar ways. It is the kind of pain that you might experience after going to the gym for a tough workout, and can actually be a signal that you are getting better.

Of course, if the pain is severe, then it is time to reassess your exercise program. Discuss this with your physical therapy professional - it could be that just one of the exercises in your program is causing the pain and discomfort, or that you need to improve your form on certain exercises. Only you can decide what is normal discomfort or if the level of pain is signaling that your body is warning you to stop what you're doing.

Find the right type of help

Depending on your condition, you may need a healthcare professional to help you develop an appropriate list of activities to engage in and to avoid, as well as to develop and instruct you on an appropriate exercise program.

Several different types of health professionals may provide physical therapy, including physical therapists, many chiropractors, and physical medicine and rehabilitation physicians (physiatrists). See also Specialists who treat back pain.

Get others in your camp

Most people misunderstand how back pain recovery works - they think that activity or exercise can cause pain, when in fact the opposite is true. This may lead your loved ones to try to continually encourage you to rest and "take it easy". It is in your best interest to educate them that active rehabilitation is in fact the best way to manage your condition. Ask them to encourage you to be active and follow your exercise program.

You may want to tell all of your friends and family about your plans to increase your activities and exercise program and ask them to encourage you. An exercise buddy or group may also help you maintain your regular exercise program.

For more information about the positive effects of exercise on back pain and specific strategies for beginning an exercise and fitness program, See Back exercise and fitness for back pain relief.

Whether used alone or in combination with other treatments, physical therapy and exercise are essential to help reduce and manage your pain, as well as to sustain your long-term recovery and prevent a future recurrence of pain. Hopefully, this newsletter will help you find and maintain a physical therapy program that works for you.

Best regards,
Peter F. Ullrich, Jr., M.D., Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com. The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board. The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.