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Lower Back Pain Worse After Physical Therapy

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What Causes Lower Back Pain

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Many injuries, conditions and diseases can cause lower back pain. They include:

  • Strains and sprains: Back strains and sprains are the most common cause of back pain. You can injure muscles, tendons or ligaments by lifting something too heavy or not lifting safely. Some people strain their back by sneezing, coughing, twisting or bending over.
  • Fractures: The bones in the spine can break during an accident, like a car crash or a fall. Certain conditions increase the risk of fractures.
  • Disk problems: Disks cushion the vertebrae . Disks can bulge from their position in the spine and press on a nerve. They can also tear . With age, disks can get flatter and offer less protection .
  • Structural problems: A condition called spinal stenosis happens when the spinal column is too narrow for the spinal cord. Something pinching the spinal cord can cause severe sciatic nerve pain and lower back pain. Scoliosis can lead to pain, stiffness and difficulty moving.
  • Arthritis: Osteoarthritis is the most common type of arthritis to cause lower back pain. Ankylosing spondylitis causes lower back pain, inflammation and stiffness in the spine.
  • Disease:Spine tumors, infections and several types of cancer can cause back pain. Other conditions can cause back pain, too. These include kidney stones and abdominal aortic aneurysm.
  • Spondylolisthesis: This condition causes the vertebrae in the spine to slip out of place. Spondylolisthesis leads to low back pain and often leg pain as well.

Why Am I Still Suffering With Back Pain After Dealing With It For 6 Months Or Longer

Most people hope that when they have Back Pain, it will simply go away on its own.

That one morning they will wake up and magically it will disappear … But then 6 months later you begin to realize that you are still living on a daily basis with back pain that is often even worse than it was when it began.

How Long Does Physical Therapy For Lower Back Pain Last

The number of sessions a patient has is truly individualized for each person. You should keep attending physical therapy until you reach your physical therapy goals.

It is also important to note that you and your therapist may change treatment goals if they do not see progress. But on average, patients can expect to be in physical therapy for six to eight weeks as strength and mobility progress with every session.

If your back pain continues to be severe or even worse, physical therapy may take longer or may be recommended after surgical intervention.

On the contrary, some patients find rapid improvement in symptoms with only a few physical therapy sessions. If that is the case, attending just a few sessions to learn exercises you can continue to do at home is helpful.

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Feeling Hopeful Or Hopeless About Chronic Back Pain

If youve ever gotten to this point, where the doctor tells you they cant find anything wrong and they send you to a pain management specialist, things can certainly begin to feel hopeless.

The first thing I would want you to understand is that youre not alone in this.

Im sure everyone reading this article has had the common cold right? Well being that 80% of people seek medical treatment for low back pain at some point in their life, the common cold is the only condition that accounts for more doctors visits per year.2,3

Of all of those doctors visits and all of those people with low back pain, upwards of 73% experience a recurrence of symptoms within a single yearyet only 5% go on to develop chronic low back pain.1 While 5% may not sound like a lot, I assure you that is many thousands of people per year.

If youre one of those in that 5% whose pain has become chronic, I want you to know that your situation is far from hopeless.

  • What causes chronic low back pain
  • What may predispose someone to developing chronic low back pain
  • Important take-aways from any imaging you may have had done
  • And finallywhat you can do right now and what physical therapy can offer you
  • The Spinal Ligament Repair Injection Treatment Option Prolotherapy

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    Summary and Learning Points of Prolotherapy to the low back

    • Prolotherapy is multiple injections of simple dextrose into the damaged spinal area.
    • Each injection goes down to the bone, where the ligaments meet the bone at the fibro-osseous junction. It is at this junction we want to stimulate repair of the ligament attachment to the bone.
    • We treat the whole low back area to include the sacroiliac or SI joint. In the photo above, the patients sacroiliac area is being treated to make sure that we get the ligament insertions and attachments of the SI joint in the low back.
    • Why the black crayon lines? This patient has a curvature of her spine, scoliosis, so it is important to understand where the midpoint of her spine is. In this patient, we are going to go up to the horizontal line into the thoracic area which is usually not typical of all treatments.
    • After treatment we want the patient to take it easy for about 4 days.
    • Depending on the severity of the low back pain condition, we may need to offer 3 to 10 treatments every 4 to 6 weeks.

    For more information on the combined use of PRP and Prolotherapy please see Prolotherapy treatments for lumbar instability and low back pain.

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    Lower Back Pain And Cancer

    Cancer involving the lumbar spine is not a common cause of back pain. However, in people who have a prior history of cancer, for example, in the breast or prostate, or who have weight loss or loss of appetite along with back pain cancer needs to be considered.

    Night pain can be a clue to cancer in the spine. A benign tumor called osteoid osteoma, which most often affects young people, causes pain that tends to respond well to aspirin. Multiple myeloma is a malignancy that occurs when the plasma cells in the bone marrow begin spreading uncontrollably. It is most common in older people, and can cause pain in many parts of the spine. When tumor or infection are suspected, blood tests may be ordered, including a CBC , sedimentation rate , and protein electrophoresis .

    Spinal Instability = Ligament Strength First Then Muscle Strength

    There are two sets of muscles in the body: mobility muscles and postural stabilization muscles.

    • Mobility muscles are important primarily for their ability to contract and create, manage, and move large joints. The triceps and bicep muscles that move the arm and the tensor fascia lata, psoas, and quadriceps muscles that move the leg belong to this first group.
    • The postural stabilization muscles are deeper muscles that contract as the mobility muscles move the joint and usually have proximal attachments that remain fixed, either on the spine posteriorly or on the sternum and ribs anteriorly . They are the anchor when the distal or furthest attachments to the mobility muscles are moved.
    • These stabilizer muscles are often referred to as core muscles since they attach to the axial skeleton and pelvis, which are considered the foundation of the human body.
  • Thus, the two sets of muscles work together, with the stabilizing muscles contracting and stabilizing a persons core as the mobility muscles move one or more peripheral joints. For example, when the tensor fascia lata and psoas muscles contract to move the lower leg, the contractions hold the pelvis in place so it cannot move, thus stabilizing it so the two mobility muscles can move the leg.
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    Reasons You Might Experience Pain After A Physio Session

    It is normal to have some treatment soreness after your session. This can last for a few hours or even up to one day depending on the severity of your condition.

    This soreness is usually related to the muscles reacting to the work that has been done on them and should not be confused with an increase in your actual symptoms.

    Stick With The Program

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    A lot of people dont follow through with their full course of physical therapy. Obvious reasons include time constraints, cost, and inconvenience. Other factors that contribute to non-compliance, according to a 2010 study in Manual Therapy, include:

    • Low levels of physical activity before treatment

    • Depression

    • Increased pain during exercise

    • Perceived barriers to exercise

    The problem with stopping PT is that you could end up right where you started: in pain and at the doctor. Now youre spending money on another healthcare visit, plus any your doctor may order for you. Thats what the authors of the Manual Therapy study were getting at when they wrote, Poor adherence to treatment can have negative effects on outcomes and healthcare cost.

    However, if you must stop PT, that doesnt mean youre destined for a lifetime of low back pain. You may not even lose the progress youve made.

    Whether or not you keep that progress depends on how much carry-through on your own. Sometimes when you stop PT, you stop doing everything and backslide.

    If you keep up with the program, then you would likely keep your progress, says Theresa Marko, DPT, CEO of Marko Physical Therapy in New York City.

    Dr. Marko notes that you may not see additional gains beyond the progress youve already made since you don’t have your physical therapist there to guide you to level up.

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    How To Massage A Beginner

    Keep your back straight as you massage and use the weight of your body to apply pressure rather than just your hands. Before you begin, place your hands on your partners back and take several deep breaths. Set the intention to be the giver and honor the gift you are about to give your partner.

    How to give beginners a good massage?

    Can Rubbing A Knot Get Any Worse

    If you untie a knot holding the line together, youre asking for trouble. In this example, I have found that the passive muscle relaxation methods are not very effective in helping you get rid of the problem and you may end up feeling worse or in pain elsewhere .

    Does pressing a knot help? Apply pressure to trigger points. When a muscle is so tight, it can restrict blood flow to that area. The theory is that when you put pressure on it, you restrict blood flow to the lump, and when you decrease the pressure, more blood flows in, he explains. The increased blood flow can help relax the muscle.

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    When Physical Therapy Fails Patients Become At Risk For Spinal Surgery They Do Not Need

    A paper published in the Journal of Advancement in Medicine by the Department of Physical Therapy, University of Utah, Salt Lake City, wanted to evaluate whether early physical therapy is more effective than a consultation where the patient was simply given education on rest, activity, and standard care options.

    In this study, 207 patients with an average age of 37 were monitored and followed up at one year. Here are the studys learning points:

    At one year both patient groups, those who had PT and those who did not report the same results

    The researchers, remember are physical therapists, they note: The potential benefits of early physical therapy should be considered in light of the time and effort required to participate in physical therapy.

    The researchers were not trying to say physical therapy did not work better than educational guidelines, what they were trying to show was that physical therapy did provide benefits for many patients. Patients who were at risk for physical therapy failure should be identified sooner.

    In the screening process of the study, patients with pain radiating into the knee area and clinical findings suggesting nerve root compression were excluded, as well as patients who had previous spinal surgery.

    Who Are These Patients At Risk For Dangerous Unnecessary Surgery

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    These are patients who suffer from pain caused by spinal instability from weakened and damaged spinal ligaments. For physical therapy, and as we will see later in this article, yoga, and pilates, to work, a person needs strong spinal ligaments. Strong spinal ligaments provide resistance to the spine and core muscles needed to strengthen the core, provide stability, and make physical therapy more successful.

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    What Are We Seeing In This Video

    In this video Prolotherapist Danielle Matias, MMS, PA-C discusses a pretty common scenario of patients who are diagnosed with sacroiliac joint dysfunction but whose MRI is normal and they try some physical therapy but it doesnt resolve the issue. The reason for this is most frequently underlying ligament laxity in the region causing SI joint instability. When ligament laxity/joint instability is found, Prolotherapy is a great option worth exploring because it stimulates ligament repair and tightening.

    How Is Low Back Pain Diagnosed

    A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.

    Tests include:

    Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.

    Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.

    Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluids pressure in the disc will reproduce the persons symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.

    Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:

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    Physical Therapy Treatment Methods

    There are 2 common forms of physical therapy:

    • Passive physical therapy, which involves treatments being applied without effort from the patient. Numerous treatment methods are available, such as applying ice packs, heat therapy, massage therapy, ultrasound, electrotherapy, and others. The goal of passive physical therapy is to help reduce pain and swelling.
    • Active physical therapy, which involves the patient moving his or her own body through exercises and stretches. By improving strength and flexibility in the neck, these muscles may become less painful and better able to maintain good posture, which reduces stress on the cervical spine.

    The initial phase of physical therapy for neck pain might involve more passive treatments, but more and more active treatments are likely to be incorporated as time goes on.

    More Advanced Care Options

    The One “Bad” Sign Your Sciatica Herniated Disc May Not Heal

    Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

    Implanted nerve stimulators

    • Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
    • Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
    • Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.

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    Mechanical Lower Back Pain

    Because it represents 97% of cases, mechanical low back pain deserves to be discussed first. To determine the factors that bring out the pain, the doctor will consider the following causes of mechanical low back pain:

    • Muscle strain.
    • Spondylolisthesis .
    • Osteoarthritis .
    • Spinal stenosis .

    Low back pain that gets worse with sitting may indicate a herniated lumbar disc . This is because certain positions of the body can change the amount of pressure that an out-of-place disc can press on a nerve. This is one reason we suggest to people with low back pain to periodically get up and stretch or walk around rather than continually stay sitting. Acute onset, that is, pain that comes on suddenly, may suggest a herniated disc or a muscle strain, as opposed to a more gradual onset of pain, which fits more with osteoarthritis, spinal stenosis, or spondylolisthesis.

    What Can Cause Lower Back Pain

    Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back fit together and move. Some examples of mechanical causes of low back pain include:


    • Skeletal irregularities such as scoliosis , lordosis , kyphosis , and other congenital anomalies of the spine.
    • Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.


    • Sprains , strains , and spasms
    • Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.

    Degenerative problems

    • Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
    • Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
    • Arthritis or other inflammatory disease in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.

    Nerve and spinal cord problems

    Non-spine sources

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