With physical therapy for back pain, there are always a number of options that are available, a number of methods and a number of techniques, from the McKenzie method to the Maitland approach, to Mulligan's mobilization techniques, and to simple modality treatments like ultrasound, electrical stimulation, and hot and cold.
The key to a physical therapy program for back pain is a few things. Number one is taking a very careful history. I think the clues are right there. When you ask a patient where the pain is, how long they've been having the pain, and is it constant or intermittent. There are a number of questions that can be asked that will really guide your treatment and your examination procedures. That's number one - a very careful, subjective history.
After that, you're looking at the range of motion and the strength of the patient. The range of motion in the lumbar spine is the first place that I would look. In the clinic, I find it very interesting that when patients are seeing a therapist for an elbow condition and the elbow is only able to flex and extend halfway, somehow the therapist is always able to know, I need to get the full range of motion in that elbow, so I'll work on both directions.
Let's say it's just limited in one direction, they'll work on that direction. When it comes to the spine and back patient, we tend to forget that principle. It's a very general rule. If they aren't able to bend forward or backwards, typically backwards, then you should work on it. That's usually a big, big, big, part of the therapy, is to try to restore the flexibility of the joints.
Once that is accomplished, you would then move on to the strengthening component. Try to see where they're weak, what muscles need to be addressed. If they have a sports-specific goal in mind, like running or basketball, then you would target certain muscles. Basically in that order of careful, subjective history, examining the range of motion and what is limited, and then using that information coupled with how much pain they're actually in and using the modality that at that time can really get the ball rolling. From there, it's pretty easy. Use strength training, posture training, et cetera, and the patients do all right.