Physical therapy is a common treatment for people with back pain and injuries, but it is important to recognize that physical therapy is comprised of many different treatment methods. The right treatment must be instituted at the correct time for the patient to provide the best results. In the beginning stages of treatment for back pain and injury, the primary problems tend to be inflammation, muscle spasm, and reduced mobility. The first goal of treatment is to reduce inflammation and muscle spasm. Proceeding too quickly to treatments that increase mobility and/or are intended to increase muscle strength and endurance can often drastically increase inflammation and spasm and can greatly delay recovery. To begin to reduce inflammation and spasm, treatments such as electrical stimulation and cold packs are often used. These therapies are often more effective than medication in reducing the patient's symptoms. Cold packs can be especially helpful when prescribed to the patient for home use to supplement in-office treatment, as the frequent application of cold therapy is the most effective means of reducing inflammation available. During the initial stages of treatment when symptoms are at their worst, applying a cold pack for 10 to 15 minutes at a time up to every two hours can bring inflammation down faster than even the most powerful anti-inflammatory drug. Once symptoms have decreased and the inflammation and spasm have subsided, treatments like massage and ultrasound may be helpful in alleviating soft tissue contraction and in improving circulation to damaged tissue to help with healing. At this stage, the severe pain is gone and the patient is primarily experiencing soreness and stiffness. As the soreness improves, stretching and mobilization can be gradually introduced to improve flexibility and mobility. Before transitioning to strengthening exercises, it is important to get the patient back to normal mobility as much as possible in order to avoid the reinforcement of abnormal movement patterns by strengthening the muscles. Muscular strengthening and postural correction exercises can be introduced once mobility has returned to normal. With back injuries and pain, poor muscle conditioning and posture were often the underlying factors that led to the original injury or pain episode. In particular, it is important to strengthen the abdominal muscles which provide stability for the spine in front, and the muscles along the back of the spine. Because it is necessary for the patient to continue the exercises on their own after being released from the physical therapist's care in order to maintain the benefits, it is important that the therapist include exercises that do not require special equipment. High-tech back rehab machines are excellent for getting patients back to health, but they should not be the sole source of the patient's rehabilitative exercise. Through proper administration of treatment by the physical therapist, and proper instruction in appropriate self-care measures, the majority of back pain patients can recover and prevent future back problems.
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