Many research studies have recommended the use of core strengthening as an adjunct in the treatment of LBP. The term “lumbar core” pertains to those muscle that lay closest to the spine and are responsible more for stabilization rather than initiating movement. Core strengthening along with general strengthen can be helpful in reducing LBP and improve strength and flexibility. Your core may become weak or reduce in its effectiveness in the presence of LBP or prolonged bouts of back pain. After completion of PT, it is important that you continue to perform your prescribed home exercise program as studies show continued improvements in back pain.
Other treatments include spinal manipulation, traction and dry needling.
Modalities to help
TENS Unit – Transcutaneous Electrical Nerve Stimulation
A TENS Unit is a device that has electrodes and a stimulating unit. The device is based on the “gait theory” which stimulates large sensory fibers that allow you to feel light touch so that this inhibits the pain sensing fibers. This is most helpful for back pain. Depending on the type of TENS unit, there can be multiple programs based on frequency and intensity. An over the counter TENS unit has high and low settings. A medical grade TENS unit will have more programming capabilities. More recent studies show TENS units can help with acute and chronic pain.
Bracing can be helpful to support the lumbar spine, reduce motion and to treat pain. An over the counter brace can be a simple elastic wrap which may help support the back in painful episodes. A medical grade brace can provide more targeted support to reduce motion in a certain direction and to reduce abdominal distention which takes pressure off the lumbar spine. Bracing can especially be helpful after a lumbar compression fracture. This will restrict motion in flexion which will help control pain. Long-term use of a brace greater than 3-4 weeks can eventually lead to weakening of the core muscles. For short term purposes or certain pain-provoking activities, a brace can be helpful.
Traction can be helpful to reduce pressure off the spinal nerves especially in the cervical spine. For an individual suffering from debilitating arm pain, a cervical traction unit may be used in physical therapy. This helps to increase spacing between the vertebral bodies and relieve pressure of the spinal nerve. A home traction unit can be useful after therapy is complete. Just remember the neck has to be flexed forward.
Mechanical traction is the use of an external device designed to impart a mechanical distraction or unloading of an irritated spinal segment. Traction may help reduce swelling and improve mobility and restore function to a dysfunctional spinal segment. The use of traction has mixed support in the research. Patients that appear to respond the best to the use of traction are those that present with leg symptoms or sciatic type pain that does not improve with other techniques and motions. Patients may also present with signs of nerve root compression and reflex changes. Traction is typically utilized early in the treatment program and only used until leg symptoms can be resolved. Traction like other modalities, are utilized per stage of impairment and used in conjunction with other treatment strategies such as mobilization and exercise.
Manual Mobilization or Manipulation
Manipulation can help reduce pain, improve ROM and restore proper function. Manipulation is a highly skilled end range technique designed to impart additional mobility to an area of restriction or hypersensitivity. Manipulation is very safe when applied correctly and has very few side effects. However, increased local soreness is commonly reported after a trail of manipulation. Spinal manipulation alone or prolonged treatments of spinal manipulation has very little support. Your therapist will work with you and your physician to determine if this treatment technique might be helpful in your program. If spinal manipulation is recommended by a physical therapist it will be combined with other treatment strategies in order to maximize the treatment benefits.
Trigger point dry needling (TDN) is a specific treatment technique that uses a solid filament needle to treat muscle trigger points and muscle/tendonus junctions. A trigger point is a highly localized, hyper-irritable spot in a palpable, taut band of skeletal muscle fibers. These muscle trigger point play a role in producing and maintaining the pain cycle. Trigger points can develop due to chronic tendonitis and prolonged mechanical stress to a tissue. Over time that stress causes changes to the tissue and prevents or delays healing to occur at that site. Trigger points develop in muscle for various reasons including referred or local pain, inflammation, tissue injury or other causes. Muscle trigger points maybe a primary source of pain as well as cause pain in adjacent tissues. Physical therapist will utilize this modality in combination with manual mobilization and manipulation. The use of electrical stimulation may also be utilized in conjunction of dry needling to help reduce pain and improve local muscle activation. Dry needling is a specific modality and is used to help reduce pain and promote tissue healing. After this type of treatment additional mobility and local activation is required to help resolve the current episode.