The most frequent prescription that I write is for physical therapy. My standard scrawl on a prescription pad reads: “Low back pain. Lumbar spine stabilization and core conditioning exercises. Teach independent home exercise program. Frequency: 2-3 times per week for 6 weeks.” This translates into 12 to 18 visits over 6 weeks with a therapist, with each session lasting about an hour. I have worked with a number of physical therapists over the years and the ones that get the best results are able to motivate the patients to do the core strengthening and conditioning exercises describe in our home remedy book.
Unfortunately, many patients are under the impression that physical therapy should feel like a spa session. They are expecting the therapist to massage the sore muscles of the back, apply a hot pack to the lower lumbar spine, and magically take the pain away. This does not work. The most effective physical therapy programs emphasize ACTIVE rehabilitation, which means that the patient is the one doing the exercise. Furthermore, this process has to happen outside of the the PT gym. It is impossible to reverse years of neglect of the muscles that lend stability to the spine with only 18 hours of physical training over 6 weeks. In my clinical practice I will often seen patient back after they have been going to PT for four to six weeks, and the patients who do well with physical therapy are the ones that put forth a genuine effort establish a routine that they incorporate into their daily lives. It typically takes 3-4 months to strengthen the core muscles to the point where the patient will notice an improvement in their low back pain. It takes even longer for the patient to notice physical changes in their body that they can be proud of. I am fond of saying that I’ll have to quit practicing medicine on the day that the model from the cover of Men’s Journal comes into clinic complaining of back pain, because so far, it just hasn’t happened. The patients that tell me that PT did nothing for them tend to have more in common with a jellyfish than the guy with six pack abs on the cover of the men’s journal.
Take home message #3: physical therapy involves a lot of hard work, and if you aren’t willing to do the work, you won’t get any of the benefit.
next topic: lifestyle choices have a huge effect on back pain