What are the functional goals of treatment for mechanical low back pain?

Updated: Mar 06, 2018
  • Author: Everett C Hills, MD, MS; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

The treatment program for mechanical low back pain (LBP) must have specific functional goals and can be outlined in the following 6 steps:

  • Control of pain and the inflammatory process - Pain treatment should be initiated early and efficiently to gain control. Ice, transcutaneous electrical nerve stimulation (TENS), and relative rest may help with controlling the pain and the inflammatory process. Excessive bedrest, however, may be detrimental by leading to lumbar segment motion, loss of muscle strength, and general deconditioning with blunting of motivation.

  • Restoration of joint ROM and soft tissue extensibility - Extension exercises may reduce neural tension. Flexion exercises reduce articular weight-bearing stress to the facet joints and stretch the dorsolumbar fascia. The use of ultrasound therapy may improve collagen extensibility.

  • Improvement of muscular strength and endurance - Exercise training can begin after the patient has passed successfully through the pain control phase. The key is to attain adequate musculoligamentous control of lumbar spine forces to minimize the risk of repetitive injury to the intervertebral disks, facet joints, and surrounding structures. Start with isometrics, then progress to isotonic exercises with effort directed at concentric strengthening.

  • Coordination retraining - Dynamic exercise in a structured training program maximizes coordinated muscle group activities that lead to postural control and the fusion of muscle control with spine stability.

  • Improvement of general cardiovascular condition - Patients are encouraged to remain active and to initiate brisk walking programs, aquatic activities, or use of stationary bicycles/stair steppers. These activities can increase endorphin levels, promoting a sense of well-being, and allow the patient to perform at a higher level of function before perceiving pain.

  • Maintenance exercise programs - A home program is developed within the tolerance and ability of the patient in order to encourage continued exercise after discharge from physical therapy.


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