December 30, 2020 Back Pain Is Such a Pain!

Back pain is one of the most common causes of disability. According to the American Chiropractic Association, around 80% of the population will experience back pain at some time in their lives. Whether you experience pain driving in your car, working out, or just bending over to pick something up, back pain does not discriminate. 


Back pain can develop suddenly, maybe with an odd lift and twist, traumatically, possibly with a fall, or gradually, noticing it more often over time. Whatever the onset, back pain is normally attributed to one of a few causes. 

Mechanical Back Pain 

By far the most common, mechanical pain comes from the muscles, ligaments, and joints in the back. This pain is usually influenced by loading the spine and often feels different based on certain motions. These can include forward bending, backward bending, or twisting.

How can a physical therapist help? 

Your physical therapist will perform a thorough movement analysis-based examination to determine if your back pain has a directional preference. They will assess for muscle weakness or stiffness that maybe contributing to your pain. They will then develop a therapeutic program based on the findings and your personal goals. This may include:

  • Posture and body mechanics-education this will teach you how to make small changes in how you sit, stand, bend, and lift to help you relieve your pain and prevent reoccurrence of injury. 
  • Stretching and flexibility utilizing our completely hands-on Active Isolated Stretching technique.
  • Aerobic and therapeutic exercises
  • Manual therapy, including joint mobilizations, western dry needling chinese cupping, trigger point release techniques, and more.

Degenerative Disc Disease

The human spine is made up of 33 vertebrae that are stacked on top of one another. Between each one is a rubbery piece of cartilage called an “intervertebral disc”. The disc has a gelatin filling and as we age, and sometimes with injury, we start to lose some of that gelatin and the volume of the disc starts to decrease, resulting in less space between the vertebrae. As a result, when the rough surfaces of the vertebral joints rub together, it can cause pain and inflammation. Sometimes, bone spurs form in a response to this degeneration of the disc, which can make the spine stiff.

How can a physical therapist help? 

Your physical therapist’s purpose is to help you continue your activities of daily living without any limitations. They will design a treatment program based on both the findings from the evaluation as well as your personal goals. This program may include:

  • Stretching and flexibility utilizing our completely hands-on Active Isolated Stretching technique.
  • Aerobic and therapeutic exercises
  • Manual therapy, including joint mobilizations, western dry needling, chinese cupping, trigger point release techniques, and more!
  • Posture and body mechanics-education this will teach you how to make small changes in how you sit, stand, bend, and lift to help you relieve your pain and prevent reoccurrence of injury. 

Spinal Stenosis

Spinal stenosis occurs when there is a narrowing within the vertebrae of the spinal column that results in too much pressure on the spinal cord (central stenosis) or nerves (lateral stenosis). 

How can a physical therapist help?

  • Stretching and range-of-motion exercises
  • Strengthening exercises focusing on your core and back muscles to provide support and help take some pressure off your spinal joints. 
  • Aerobic and therapeutic exercise
  • Manual therapy, including Western dry needling, Chinese cupping, trigger point release techniques, and more.
  • Use of equipment (Your physical therapist could use a rehabilitation equipment such as our traction machine)
  • Gait training to reduce compression. 

Herniated Discs

Now remember, the spine is made up of 33 vertebrae (bones) stacked on top of each other with rubber like discs in between. As people age, their discs can lose some flexibility and this causes the gelatin filling to leak through the tear, resulting in a herniated disc. 

How can a physical therapist help?

  • Improve strength especially core and pelvic stabilization to reduce the stress on the low back. 
  • Improve posture and implement a home program individualized to the patient with teachings of proper body mechanics with functional activities so they can return to their desired activities.  


rubberlike substance called “hyaline cartilage”, found on many joint surfaces, decreases the friction when you move. Another protective substance is called “synovial fluid” and is contained within the joints. When they break down, the bones begin to rub together when you move. 

How can a physical therapist help?

  • Design an individualized program to address your specific needs and improve your movement
  • Use hands-on manual therapy to improve movement of the affected joint
  • Design and implement a progressive therapeutic exercise program to be performed in office and at home


Osteoporosis is a bone disease identified by low bone density, decreased bone strength, and a change in the bone structure, which can lead to an increase risk of fracture. Bone is living tissue and typically new bone is formed in a balanced, ongoing process. With osteoporosis, bones weaken when not enough new bone is formed and/or too much bone is lost. 

How can a physical therapist help?

  • Design and implement exercises to build bone or decrease the amount of bone loss
    • Stimulate bone absorption of calcium and phosphate salts using a partially unweighted walking program in the Alter-G anti-gravity treadmill and a weight training program. 
  • Coach you on proper alignment and posture during your activities of daily living
  • Correct any imbalances causing extra stress


Acute back pain, often caused by a strain or overuse, is usually short lived and should resolve within a matter of days with relative rest, including gentle walking and stretching. If your back pain persists for 3 weeks or more, you should consider being evaluated by a physical therapist. Back pain turns chronic if it lasts for more than 3 months. 

A few symptoms you may be experiencing could include:

  • A dull aching sensation in the upper or lower back
  • A stabbing or shooting pain that can radiate down the leg or around the front
  • An inability to stand up straight without pain 
  • A decreased range of motion and diminished ability to flex the back 

When to seek intervention

Some back pain will gradually improve with at home treatment and self-care, typically within 1-2 weeks. 

You should get an evaluation with a physical therapist if you’re experiencing pain that:

  • Continues pasts 3 weeks
  • Is severe and doesn’t improve with rest
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness, or tingling in one or both legs
  • Is affecting your activities of daily living

“Here at TSMG, we have a variety of interventions that we can do to help you get rid of your back pain. The most important thing is that we need to focus on function. First, we’re going to ask you the things you want to be able to get back to doing. Then, once we know that we can perform a detailed movement assessment to see if your pain comes on with certain movements like bending forward, bending backward, or twisting. Once we know those things, we can identify maybe joints, muscles, or the variety of structures in your body that might be involved. From there, here we use a lot of hands-on techniques coupled with movement-based therapies. Some of the hands-on techniques that we use here are mobilizations and manipulations of the spine or joints as well as augmented soft tissue release. We also use Western dry needling techniques and a variety of other instrumental techniques to get into the tissue themselves. After we have warmed up the tissues with those techniques, we’ll bring you back to our large gym where we can do a variety of different exercises targeting specific muscle groups. We will also designate a few exercises for you to do at home as well as change some of your functional activities to help reduce your pain. Would love to see you here at Tennessee Sports Medicine Group!”

Caitlin Kothe PT, DPT, MS, CSCS
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