What is included in physical therapy for acute 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 main goal of physical therapy in persons with acute back pain is not to increase strength but to achieve adequate pain control. No benefit has been demonstrated for strengthening exercises in persons with acute back pain. Exercise should begin with extension exercises in the prone position after lateral trunk shifts and then progress, as tolerated, to prone lying with support. Flexion exercises can be performed only if the patient has no acute dural tension. [22, 23]

The spine should be stabilized using strengthening of segmental muscles followed by the prime movers of the spine (ie, latissimus dorsi, abdominals, erector spinae). Muscle groups should be strengthened in a neutral position to decrease tension on ligaments and joints; this position allows balanced segmental forces between the disks and the zygapophyseal joints and maximizes functional stability with axial loading.

Physical therapy programs should also include positioning the patient to maximize comfort. Loosening of the hamstrings, glutei, gastrocnemius/soleus group, tensor fascia latae, quadriceps group, and hip flexors also contributes to reduction of LBP and effective conditioning.


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