Role of physical therapy in the management of common low back pain

Abstract

Physical therapy (PT) is widely used in the management of common low back pain. Its immediate goals are to reduce pain and restore mobility and function. But ultimately, it must prevent recurrences and chronicity of back pain, decrease disability time and reduce unwarranted medical use. The role of the physician is described in Chapter 5. The physical therapist must perform an initial physical therapy evaluation on each patient to determine the appropriate PT treatments. The therapist should know the patient's past and present medical history, activity level, psychosocial background and work. At the end of the PT evaluation, the therapist should be able to summarize the functional findings and provide both shortand long-term goals of the PT programme (see Appendix). This evaluation and the subsequent progress of the patient's therapy is conveyed to the referring physician and to the multidisciplinary team. Aside from communication between physical therapist and treating physician or the therapeutic team, there should be a close relationship between the physical therapist and the patient. Patients must be informed of the nature and natural course of common low back pain, in accordance with the terminology used by the other members of the team. The patients must understand that they themselves must play an active role in their own rehabilitation. The general classification of PT treatments used for patients with common low back pain is shown in Table 1. Passive modalities should only be used temporarily if in preparation for exercises or pain does not permit the patient in the acute or subacute stage to participate in an active programme. Relaxing modalities, such as heat and postures, could be taught to the acute patient for self-care and pain modulation at home. In chronic low back pain with disability, passive PT modalities have few indications. In the following pages, the different PT modalities as enumerated in Table 1 are reviewed. A reasonable approach is then developed for the use of PT.