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Physical Therapy intervention begins with a thorough initial evaluation including
a history of the pain. By understanding the onset of the pain (sudden/traumatic
versus gradual/for "no apparent reason"), positions that seem to make the pain
better or worse, and the specific postures and stresses the individual undergoes
on a regular basis-for job, recreation, or activities of daily living-the PT
can help to get at the underlying problems causing the pain. For example, if
someone is starting to suffer the effects of degenerative changes in the disks
or spine, the PT can help to decrease the abnormal and excessive stress to the
spine through postural and body mechanics training, patient education regarding
work space set-up, and therapeutic exercise to address tightness and/or weakness
which might be contributing to abnormal wear and tear of specific structures
like the disks or joints.
After the history taking is completed, the PT takes an objective look at the
person. The evaluation includes assessment of spine as well as arm/leg flexibility,
strength, and postural alignment among other things. Walking is also observed
to note gait abnormalities that might contribute to pain. The person is then
taken through motion testing in all directions of either the neck or back (often
repeatedly) to help determine the nature of the pain and deficits in motion.
After the evaluation, the PT will come up with a "mechanical diagnosis" (versus
the medical diagnosis given by a doctor, like degenerative disk disease). Based
on the findings, history, and mechanical diagnosis, an individualized treatment
program is designed to address the specific deficits that have been identified.
Types of Conditions that Physical Therapy Can Help
Physical Therapy can help acute and chronic neck and back pain resulting from
a variety of diagnoses. Types of conditions include, but are not limited to:
1.) Neck and lumbar sprains and strains
2.) Degenerative disk and joint disease of the spine
3.) Bulging or slipped disks
4.) Stenosis
5.) Myofascial pain of the back or neck
6.) Chronic headaches
7.) TMJ dysfunction
Ideal Candidates for Physical Therapy
In order for Physical Therapy to be truly effective, the patient must be willing
to take the responsibility for getting better. This includes regularly attending
scheduled appointments to learn postures, techniques, and exercises to be employed
as part of a "home program" to address the neck or back pain. While "passive
modalities," including massage or various electrical or thermal agents, may
be used initially in conjunction with therapeutic exercise and postural training,
it is "active" things like postural and body mechanics awareness and commitment
to the exercise program that are responsible for the most significant and lasting
decreases in pain. An ideal candidate for PT is someone who says, "I want to
learn what I can do to get rid of this pain once and for all, or at least to
know how to control or prevent it." This is in contrast to a less ideal candidate
who comes to PT looking for something external to be applied that will "fix"
the problem.
Physical Therapy Interventions
Specific Physical Therapy interventions for neck and back pain include therapeutic
exercise (Figure A) (on mats, on balls, in the water, etc.), manual techniques
(soft tissue massage to help improve stretching or gentle joint mobilization
to help improve flexibility), training in proper body mechanics and posture,
and patient education regarding ergonomics at work or in the home. (Note: ergonomics
is adapting the environment to address a specific body's needs; for example,
changing the set up of a work station to help employ better body mechanics with
computer use.)
Figure A
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