If you have tried physical therapy to relieve your low back pain you might have encountered this phenomena: your back actually starts to feel worse than before your started the exercises!
In this article we take a look at this problem, look at why it happens, and when you should consider pushing through the pain to get the relief your back deserves.
No Pain, No Gain For PT?
Embarking on the road to recovery from low back pain can be a journey of mixed emotions. While physical therapy stands, globally, as one of the most evidence-based treatments it can sometimes lead to an unexpected twist: pain in the beginning before true relief kicks in.
In this comprehensive guide, we'll dig into the data and explore the science behind why physical therapy can seem to make things worse, when in fact it is making things better. The good news is that if this is something that has happened to you you are not alone - it is more common than you think.
The other good news is that pain actually often means progress! If your muscles are having a moan it can actually mean that you are on the road to recovery. Let's look at the transformative power of physical therapy for low back pain and how it can pave the way for a pain-free, active life.
The Evidence-Backed Foundation of Physical Therapy
Before delving into the discomfort, it's important that we understand why physical therapy is seen by so many healthcare experts as being the basis of low back pain management.
The Endorsement of Guidelines Worldwide
Around the globe, leading medical authorities and healthcare organizations advocate for the inclusion of physical therapy in the treatment of low back pain.
From the American College of Physicians to the National Institute for Health and Care Excellence (NICE) in the UK, these endorsements underscore the effectiveness and safety of physical therapy as a primary intervention.
International healthcare organizations all share the same recommendations for managing low back pain, emphasizing evidence-based treatments like physical therapy.
Here's a brief overview of their key suggestions:
American College of Physicians (ACP): Prioritizes non-invasive treatments, with physical therapy at the forefront for acute, subacute, and chronic low back pain. They advocate for structured exercise programs before considering medications or invasive procedures.
National Institute for Health and Care Excellence (NICE - UK): Stresses the importance of tailored exercise programs, including spinal manipulation, supervised exercise, and yoga, as first-line treatments. They also emphasize the delivery of treatments by trained professionals and focus on individualized care.
World Health Organization (WHO): Highlights the significance of maintaining or returning to daily activities through physical therapy and exercise programs. Urges caution in unnecessary imaging or surgery, unless clearly indicated.
Australian and New Zealand Guidelines: Align closely with international recommendations, emphasizing the role of physical therapy, exercise, and self-management strategies as primary interventions. Empowers patients to take an active role in their recovery through education and tailored exercise programs.
European Guidelines: Advocate for a multidisciplinary approach, with a strong emphasis on individualized care, addressing psychosocial factors, and promoting self-management strategies. Recognize physical therapy as a vital component in chronic low back pain management.
These guidelines all emphasize that physical therapy is an essential, evidence-backed approach for non-invasive low back pain management. It stands as a first line choice, supported by solid scientific evidence, in the journey towards recovery from this life-limiting condition.
The Paradox: Feeling Worse Before Feeling Better
For many individuals beginning physical therapy for low back pain, the experience can be paradoxical. Rather than feeling immediate relief, you might actually find that your first sessions leaves you feeling stiff and sore.
This phenomenon, while disconcerting, is a natural part of the healing process. Here's why it happens:
1. Muscle Activation and Engagement
During physical therapy, targeted exercises are designed to engage and strengthen specific muscle groups. In the case of low back pain, this often involves activating muscles that may have become weakened or that have been used less. As these muscles start to work harder, they can generate a temporary sense of soreness or fatigue.
Delayed onset muscle soreness (DOMS) also known as 'muscle fever'. It is generally defines as being a "sore, aching, painful feeling in the muscles after unfamiliar and unaccustomed intense exercise".
Having DOMS after you exercise is usually a positive sign. It is an indication that the muscle is getting stronger than it was before the exercise and that means the exercise is working. This can happen when people haven't been using certain muscles and then they start physical therapy.
2. Correcting Movement Patterns
Physical therapists often work to correct faulty movement patterns that commonly contribute to low back pain. This work can involve adjustments to the patient's posture, gait, and body mechanics. Initially, these corrections may feel funky or even slightly uncomfortable as your body adapts to new ways of moving.
An example of this is something as simple as just standing up straight after slouching for a while. Standing up straight can feel strange and may even put some strain on your muscles. It doesn't mean it isn't good for you or that those muscles aren't getting stronger and better! Keep going!
3. Addressing Soft Tissue Restrictions
Soft tissues surrounding the spine and other affected areas play a crucial role in our experience of low back pain. Physical therapists use techniques like manual therapy (think massage) and stretching to address tightness in these tissues.
While it is true that these interventions are therapeutic, they can sometimes trigger tenderness and discomfort.
4. Unmasking Hidden Issues
Physical therapy can reveal underlying issues that were previously masked by compensatory mechanisms. In other words, there might be some musculoskeletal or biomechanical issues that a person's body might have compensated for in some way or another that you weren't even aware of.
These compensations can be in the smallest of things that we might not always notice. They can include things like changes in how a person moves, how their posture has changed, or even if they might be shifting their weight to one side or another. Small changes in our posture or movements can add up to some big changes over time.
How Compensatory Mechanisms Can Impact Back Pain
When someone starts physical therapy, these compensatory mechanisms are gradually identified and corrected. As a result, any discomfort or pain that was initially masked by these compensations may make themselves known. This is a natural part of the healing process as the body gets used to using the proper (more optimal) movement patterns and alignment.
One example of this is found in a 2022 study, published in the European Spine Journal that found that people with low back pain often use the wrong muscles when moving from a sitting position to a standing position (Sit To Stand).
These people tend to put more pressure on their lumbar spine than their hips, so teaching people how to strengthen their core and use the correct muscles for the correct movements can make a big difference over a long period of time.
5. Managing Inflammation and Tissue Healing
In some cases, physical therapy interventions may lead to improvements in the muscles like increased blood flow and better mobility. While this is a huge part of the healing process, it can also sometimes result in temporary inflammation of the muscles or soreness.
Recent studies have shown some indications that inflammation may actually play a role in muscle cell regeneration and repair. So some soreness might actually mean that things are getting better!
The Light at the End of the Tunnel: Perseverance Pays Off
It's crucial to recognize that the initial discomfort experienced during physical therapy is often a positive sign. More frequently than not it signifies that the body is responding to the treatments we are doing and that they are in the process of healing.
With consistent effort and expert guidance, these sensations gradually subside, paving the way for lasting low back pain relief and improved function.
Conclusion: Trusting the Process, Embracing the Progress
While the journey through physical therapy for low back pain may present moments of temporary discomfort, it's important to view these sensations as indicators of positive change.
With expert guidance and a commitment to the process, the initial discomfort gives way to enduring relief and a restored quality of life.
Remember, the road to recovery is often paved with small victories - each one bringing you closer to a future free from low back pain.