First Visit
Your physical therapist (PT) will gather information about your spine condition. You may be asked questions about when it started, where you hurt, and how your symptoms affect your day-to-day activities. This helps your PT to begin zeroing in on the source of your problem and to know what will be needed to help relieve it.
Therapy Exam
After reviewing your answers, your therapist will do an exam that may include some or all of the following checks.
Posture – Imbalances in the position of your spine can put pressure on sore joints, nerves, and muscles. Improving your posture can oftentimes make a big difference in easing pain.
Range of motion (ROM) – Measurements are taken of how far you can move in different directions. Your ROM is recorded to compare how much improvement you are making with treatment.
Nerve Tests – Your PT may do checks of reflexes, sensation, and strength. The results can help determine which area of the spine is causing problems and the types of treatment that will be best for you.
Manual Exam – Your PT will carefully move your spine in different positions to make sure that the joints are moving smoothly at each level. Muscle and soft tissue flexibility is also tested.
Ergonomics – Ergonomics involves where and how you do your work or hobby activities. By understanding your ergonomics, your PT can begin to learn if the way you do your activities is making your condition worse. Sometimes even simple corrections of your hobby or workstation can make a big difference in easing spine problems.
Palpation – Palpation involves feeling the soft tissues around your spine. This is used to check the skin for changes in temperature or texture, which could tell if you have inflammation or nerve irritation. Palpation also checks whether there are tender points or spasms in the muscles near the spine.
Controlling Pain and Symptoms
Your therapist may choose from one or more of the following treatment interventions to help you control your pain and symptoms.
Rest
Resting the painful joints and muscles helps calm soreness, giving your spine time to heal. If you are having pain with an activity or movement, it should be a signal that there is still irritation going on. You should try to avoid all movements and activities that increase the pain. In the early stages of your problem, the doctor or therapist may have you wear a brace to limit movement.
Specific Rest
Specific rest encourages safe movement of the joints and muscles on either side of a painful area, while protecting the sore spot during the initial healing phase. If a brace was prescribed, you may be instructed to take it off a few times each day so you can do some gentle and controlled exercises.
Positioning
Your PT will work with you to find ways to position your spine for the greatest comfort while sleeping or resting. You may receive advice on positions that reduce stress on your spine while you are at work.
Ice
Ice makes blood vessels vasoconstrict (get smaller), decreasing the blood flow. This helps control inflammation, muscle spasm, and pain.
Heat
Heat makes blood vessels vasodilate (get larger), increasing the blood flow. This action helps flush away chemicals that cause pain. It also helps bring in healing nutrients and oxygen.
Ultrasound
Ultrasound can reach tissues that are over two inches below the surface of your skin. The ultrasound machine directs high-frequency sound waves toward the sore area. As the waves pass through the body’s tissues, they vibrate molecules. The vibration causes friction and warmth. The remaining sound waves are converted to heat in the deeper tissues of the body. This heating effect helps flush the sore area and brings in a new supply of blood that is rich in nutrients and oxygen.
Electrical Stimulation
Electrical stimulation is a gentle treatment used to stimulate nerves. The current passes through pads applied on the skin. Some people say it feels like a massage on their skin. Electrical stimulation can ease pain by sending impulses that are felt instead of pain. Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.
Soft Tissue Mobilization/Massage
Therapists are trained in many different forms of massage and mobilization. Massage has been shown to calm pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants that come from inflammation. Soft tissue treatments can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease.
Joint Mobilization
Graded pressures and movements for joint mobilization may be performed by skilled therapists. Gentle graded pressures help lubricate joint surfaces, easing stiffness and helping you begin moving with less pain. As your pain eases, more vigorous grades of mobilization may be used to lengthen tissues around the joint in order to restore better movement in your spine.
Traction
Sore joints and muscles often feel better when traction (pull) is used. Therapists apply traction manually or with a traction machine. There are also traction devices that can be issued to you for use at home. The amount of pull that is used will depend on your condition. A gentle on/off pressure may be better early on to help control arthritis pain. More vigorous traction can help take away pain if a spinal joint is mildly sore or tight.
Therapeutic Exercise
Specialized treatments and exercises can help maximize your physical abilities, including flexibility, stabilization, coordination, and fitness conditioning.
Flexibility
Exercises that increase flexibility help to reduce pain and make it easier to keep your spine in a healthy position. Flexibility exercises are helpful for establishing safe movement. Tight muscles cause imbalances in spinal movements. This can make injury of these structures more likely. Gentle stretching increases flexibility, eases pain, and reduces the chance of re-injury.
Stabilization
The “core” muscles you’ll be working on are closer to the center of the body and act as stabilizers. These key muscles are trained to help you position your spine safely and to hold your spine steady as you perform routine activities. These muscles form a stable platform letting you move your limbs with precision. If the stabilizers aren’t doing their job, your spine may be overstressed with daily activities.
Coordination
Strong muscles need to be coordinated. As the strength of the spinal muscles increases, it becomes important to train these muscles to work together. Learning any physical activity takes practice. Muscles must be trained so that the physical activity is under control. Spine muscles that are trained to control safe movement help reduce the chance of re-injury.
Fitness conditioning
Improving overall fitness levels aids in recovery of spine problems. Fitness conditioning involves safe forms of aerobic exercise. The term aerobic means “with oxygen.” When using oxygen as they work, muscles are better able to move continuously, rather than in spurts.
Exercise has other benefits as well. Vigorous exercise can cause chemicals, called endorphins, to be released into the blood. These chemical hormones act as natural pain relievers in reducing your pain. Examples of aerobic exercise include
- swimming laps
- walking on a treadmill
- using a cross country ski machine
- using a stair stepper
If you decide you want some extra conditioning, always check with your doctor or therapist before beginning a program on your own. It is important that you choose an aerobic activity you enjoy. This will help you stick with it-guaranteeing you the long-term benefits that come with a well-rounded fitness program.
Functional Training
Therapists use functional training when you need help doing specific activities with greater ease and safety. Examples include posture, body mechanics, and ergonomics.
Posture
Using healthy posture keeps the spine in safe alignment, reducing strain on the joints and soft tissues around your spine. The time and effort you take to use good posture are vital to spine care, including prevention of future spine problems. As you gain strength and control with your stabilization exercises, proper posture and body alignment will be easier to remember and apply with all your activities.
Body Mechanics
Think of body mechanics as putting safe posture into action. It’s one thing to sit or stand with good posture, it’s another to keep safe posture as you actually move with activity. You want to keep your body in its safest alignment as you go about your daily tasks, such as
- getting out of a chair
- taking out the trash
- getting clothes out of the dryer
- brushing your teeth
- lifting
Safe body movement is especially important during lifting. To avoid extra spine strain when lifting, use these safety tips.
- Plan and prepare for the lift.
- Make sure you have good footing.
- Straddle your feet with a wide base of support.
- Keep the load close.
- Keep the spine stable and aligned.
- Avoid twisting by pivoting with your feet.
Ergonomics
Ergonomics looks at the way people do work. It’s possible that even minor changes in the way you do your work or hobby activities could keep your pain and symptoms in check, while protecting your spine from further injury. Ergonomics doesn’t usually involve expensive changes. Even minor adjustments in the way you do your activities can make a huge difference in easing your pain and preventing further problems.
Home program
Once your pain is controlled, your range of motion has improved, and your strength is returning, you will be progressed to a final home program. Your therapist will review some of the ideas listed above to help take care of any soreness at home. You’ll be given some ways to keep working on your range of motion and strength. Before you are done with therapy, more measurements may be taken to see how well you’re doing now compared to when you first started in therapy.
