6 Steps to Get Pain Relief with Physical Therapy and Exercise by Sylvia Marten

The use of some type of physical therapy or exercise is integral to almost all forms of back and neck pain treatment. Sometimes physical therapy and exercise are the first lines of treatment, other times it may help manage chronic pain, or provide rehabilitation after surgery. But did you know that both gentle back exercise and physical therapy play a vital role in relieving pain?

Physical therapy and exercise are perhaps the most mainstream of all non-surgical treatments for back pain and neck pain. And unlike other conservative treatments (medication, injections, etc.), physical therapy can also help prevent and/or lessen future recurrences of back pain or neck pain. Below are 6 steps you can take to get pain relief from incorporating physical therapy or another kind of exercise into your routine.

Please remember that it is always advisable to check with your physician prior to beginning any exercise program.

Find the right type of help.
Depending on your condition, you may need a healthcare professional to help you develop an appropriate list of activities to engage in and to avoid, as well as to develop and instruct you on an appropriate exercise program.

1. Several different types of health professionals may provide physical therapy, including physical therapists, many chiropractors, and physical medicine and rehabilitation physicians (physiatrists).

2. Alleviate the acute pain before you begin to exercise.
When you’re in a lot of pain, the thought of active rehabilitation and exercise can be pretty daunting. 1 or a combination of the following passive pain-relieving techniques (modalities) may be used:

-Electrical stimulation (e.g. TENS units)
-Heat and/or cold therapy
-Ultrasound
-Massage therapy
-Manual manipulation
-Other treatments may also be needed to sufficiently reduce your pain. All of the above therapies are designed with one goal in mind: providing enough pain relief to help you progress to an active exercise program.

3. Get others in your camp.
The common belief is that to heal back problems, those who experience pain should refrain from physical activity. Consequently, many of your friends or family may encourage you to rest if the exercise is causing you to struggle. By explaining ahead of time, they can understand how active rehabilitation is best for managing your condition. If you want support or help, you can also ask them to join you or encourage you during your exercises.

4. Engage in active physical therapy (exercise).
Active exercise is necessary to help the back heal and stay healthy. While some of the muscles that provide support for the spine are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.

Any exercise program for the back should include a combination of stretching, strengthening, and low-impact aerobic exercise.

Also consider water therapy. Exercises that would normally be too painful to do on land, such as walking, often become tolerable to do in the water. Not only does the water provide the therapeutic effect of relieving pain, it helps get you ready for more extensive exercise.

5. Expect some initial discomfort.
Beginning an exercise program after an episode of back pain, or if you suffer from chronic back pain, will almost always cause some increase in your pain at first.

However, the pain experienced when doing an appropriate exercise program for back pain should be “good pain.” This pain is to be expected as a natural part of increasing activity—stretching tissues that have become stiff and using muscles in unfamiliar ways. It is the kind of pain that you might experience after going to the gym for a tough workout, and can actually be a signal that you are getting better.

See Stretching for Back Pain Relief

Of course, if the pain is severe, then it is time to reassess your exercise program. Discuss this with your physical therapy professional – it could be that just one of the exercises in your program is causing the pain and discomfort, or that you need to improve your form on certain exercises. Only you can decide what normal discomfort is or if the level of pain is signaling that your body is warning you to stop what you’re doing.

6. Carefully pace yourself.
When returning to activity after an episode of pain or following surgery, you absolutely will want to pace yourself. The danger is getting in a pattern of beginning a day with minimal pain, and subsequently engaging in so many activities that you relapse with severe pain.

A much healthier approach to rehabilitation is to pace your activities regardless of how you are feeling in order to keep the pain under relatively good control and prevent a flare-up.

Whether used alone or in combination with other treatments, physical therapy and exercise are essential to help reduce and manage your pain, as well as to sustain your long-term recovery and prevent a future recurrence of pain. Hopefully, this will help you find and maintain a physical therapy program that works for you.

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The McKenzie method is a classification system and a classification-based treatment for patients with low back pain. A acronym for the McKenzie method is mechanical diagnosis and therapy (MTD). The McKenzie method was developed in 1981 by Robin McKenzie, a physical therapist from New Zealand.
The McKenzie method exists of 3 steps: evaluation, treatment and prevention. The evaluation is received using repeated movements and sustained positions. With the aim to elicit a pattern of pain responses, called centralization, the symptoms of the lower limbs and lower back are classified into 3 subgroups: derangement syndrome, dysfunction syndrome and postural syndrome. The choice of exercises in the McKenzie method is based upon the direction (flexion, extension or lateral shift of the spine). The aims of the therapy are: reducing pain, centralization of symptoms (symptoms migrating into the middle line of the body) and the complete recovery of pain. The prevention step consists of educating and encouraging the patient to exercise regularly and self-care. All exercises for the lumbar spine are repeated a number of times to end-range on spinal symptoms in one direction. When you do only 1 repetition, this will cause pain. When you repeat it several times the pain will decrease. Also after movement termination the changes in pain intensity can persist, which leads to a treatment modality. A single direction of repeated movements or sustained postures leads to sequential and lasting abolition of all distal referred symptoms and subsequent abolition of any remaining spinal pain. For more information on the McKenzie method, Click here

In 10 days, with five physical therapy sessions and me faithfully doing the “extension” exercises four to six times a day at home, I achieved total relief from my severe back pain. From the very first day, the McKenzie therapist told me I should continue playing golf because walking was good for the back, but he told me to do the standing extensions between swings. I played golf after every therapy session. But keep in mind that if your pain has been present for many months, it will likely take longer to gain relief. Give yourself a couple of weeks of faithfully doing the exercises.
As long as I continue doing the extension exercises, along with maintaining correct posture, I expect I’ll continue to have a pain-free back. I now do the extension exercises described above twice a day as part of my normal routine, plus I’ve added several flexion exercises, that is, exercises that have me bending my spine forward. Doing the flexion exercises once you are healed is necessary because the healed tissues and any scar tissue formed during the healing process must be made pliable again so it is not subject to overstretching and re-injury. Flexion exercises include the several bending forward movements (toe-touching, etc.) traditionally recommended to stretch the back muscles. Go slowly when resuming the flexion exercises.
It is important to remember that every session of flexion exercises must be followed by a few extension exercises. Simple standing extensions will suffice.
I do both flexion and extension exercises now, but I do far more extension exercises. Almost every time I rise from a sitting position, I do a couple of standing extensions. And while playing golf, I perform standing extensions before I swing the club and at any time my back feels a bit tight. Good posture, of course, has become part of my life.

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