For lower back pain that has lasted between two and six weeks, or frequently recurs, physical therapy may be considered. Some specialists begin physi- cal therapy sooner, especially if the pain is severe. Physical therapy can help decrease back pain and increase the patient’s ability to function, and pro- vides a routine that can help prevent recurrence of the problem.

Physical therapy can be passive (something is done to the patient) or active (the patient engages in an exercise program).

Initially, therapists may need to focus on reducing the pain, which is often done with the following passive modalities:

Heat/ice packs
Heat and ice are very commonly used to help reduce muscle spasm and inflammation, as well as reduce the amount of pain experienced, and also assist in healing. The therapist may apply this treatment, but if a non-professional is going to do it a medical care provider should be consulted before beginning to be sure it will be done correctly. Importantly, care should be taken with both ice and heat so as not to burn the skin.

Some patients experience better pain relief by using heat and others have better results with ice. Many find that the best approach is to alternate the two. Treatments should last ten to twenty minutes once every two hours, and are most useful in the first few days of a flare-up of pain.

• Physical therapy - Passive PT (modalities) for back pain • Heat therapy, cold therapy and ice massage therapy • Benefits of heat therapy for lower back pain • Back pain exercises and physical therapy

Iontophoresis
Iontophoresis is a way to deliver steroids through the skin. The steroid is applied to the skin, and an electrical current is then applied that causes the steroid to migrate under the skin. The steroids then produce an anti- inflammatory effect in the area of the pain. This is especially effective in relieving acute pain.

TENS Units
A transcutaneous electrical nerve stimulator (TENS) unit emits electrical stimulation into the area of the lower back pain. This stimulation overrides the pain signals that are sent to the brain, and can be effective in relieving pain. Usually a therapist will do a trial with this therapy on a patient, and if substantial pain relief is experienced the unit may be sent home with the patient to be used as needed for long-term pain relief.

Ultrasound
Ultrasound is a form of deep heating in which sound waves are applied to the skin and penetrate into the soft tissues. This modality is especially useful in relieving acute episodes of pain and may also enhance tissue healing.

Once the pain is lessened through passive therapies, active physical therapy (exercise) is needed to rehabilitate the spine. Therapists will work with patients to develop a proper exercise routine that will help patients avoid recurrences of low back pain, and help reduce the severity and duration of potential future episodes of low back pain.

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