When you're suffering from back or neck pain, it may be tempting to stay on the couch all day. But that's a prescription for more pain. Although getting up and moving might be the last thing you feel like doing, physical therapy and exercise can be the best way to reduce pain.
Always talk with your doctor and get his or her approval before beginning a physical therapy or exercise program. That said, if you've gotten a green light, the first thing to do is get some information.
Q&A about physical therapy
Jason Pan, MD, Assistant Professor of Physical Medicine and Rehabilitation at Penn Medicine, explains why physical therapy is important, and how you can exercise to relieve pain in the back or neck.
What is the best type of exercise to do for spine or back pain?
Dr. Pan: In general, aerobic activity is a good first step. Exercises like jogging, walking, using the stationary bike — these are all light aerobic activities that have been shown to decrease back pain. Core strengthening exercises are also helpful for back pain.
When it comes to specific exercises or intensity of the exercise, that's very individualized. What's helpful for one person may make someone else's back or neck hurt more. A physical therapist can help you find the exercises that are right for you, and teach a home exercise program that will benefit you in the long-term.
Is there anything you shouldn't do if you have pain in the spine or back?
Dr. Pan: This is also different for each patient, but there are a few rules of thumb. The overarching theme is to not do any exercise that is painful. In other words: "let the pain be your guide." The proper exercises should be relieving pain, not causing more of it. Sometimes it is difficult to distinguish between soreness from working out your muscles versus pain that is a sign of harm — this is where a trained physical therapist can help guide you and make sure the exercises are appropriate for your situation.
It's also important for people with back or neck pain in certain areas to avoid actions that will make that particular type of pain worse.
What are some examples of that?
Dr. Pan: Some people have back pain related to a problem with a disc, such as a herniation (slipped out of place). These patients usually have the most pain when they’re bending forward, especially in the morning. The disc isn’t ready to absorb the force or weight of bending over just yet.
We tell patients with disc problems to avoid activities that involve bending forward at the waist or twisting for at least the first 45 minutes of the morning, especially if any lifting is involved.
If you are still struggling with back and neck pain, the Penn Spine Center offers an online assessment test to help you learn when it is time to see a doctor for the pain.
Online Back and Neck Health Assessment Test
If a patient doesn't want to do physical therapy, are there other treatment options?
Dr. Pan: There are medications, injections, and, in some cases, surgeries. But these are usually offered alongside physical therapy, because physical therapy is one of the most beneficial and long-lasting treatment options. Medications and injections can be helpful, but are typically short-term treatments that don’t completely fix the underlying source of pain.
There are also complementary and alternative options, such as acupuncture.
Do patients need to see a physical therapist, or can they just do exercises at home?
Dr. Pan: I always recommend going to formal physical therapy, for multiple reasons.
The first is eliminating distractions. It’s easy to plan to exercise at home, but then the phone rings, something happens at the house, you get busy—and the exercising gets pushed off.
Physical Therapy is dedicated, unobstructed time focused on healing your body. And if you’ve already made an appointment, you will feel more responsibility to go.
The second is the mechanics of the exercises themselves. It can be difficult to do the exercises on your own, and certain ones can cause more pain if they’re not done the right way. A therapist can observe you, and make sure you’re doing everything correctly.
Finally, physical therapy isn’t just a place to get better—it’s also a place to get educated. The goal is not to be in therapy forever, but to learn the exercises that you can take home and incorporate into your own routine.
Is physical therapy more important for certain types of back pain?
Dr. Pan: There are two general categories of back pain. Acute back or neck pain — which comes on suddenly — can have many different diagnoses. It can be as benign as a muscle strain, to as serious as a severe spinal cord injury. The treatment is really dictated by the exact diagnosis.
The other category is chronic back or neck pain, where the pain may have come on more gradually, without a clear injury event. Chronic back or neck pain is typically due to wear-and-tear changes, such as a degenerated disc or osteoarthritis.
Even though there are different types of back and neck pain, we recommend physical therapy for both acute and chronic back or neck pain, so long as the acute pain does not require immediate medical or surgical intervention.
The good news for acute back or neck pain is that, in general, the majority of patients feel about 80 to 90 percent better after six weeks.
How do you determine the best types of exercises for each patient?
Dr. Pan: One of the most popular physical therapy approaches is the McKenzie Method. It assesses how pain affects a patient based on certain movements, such as flexing forward or extending backward. It tests which movements worsen or improve the back or neck pain.
Based on these results, we can determine which strengthening and stretching exercises are the most appropriate, so that these movements don’t cause as much pain.
If physical therapy doesn't seem to be helping, does that mean the injury is more serious?
Dr. Pan: Not necessarily, but it could mean that you need another form of treatment. If you have persistent back pain for three to four weeks despite exercising, see a physician.
Whether or not you’re in physical therapy, you need to see a physician if you notice certain other symptoms along with back or neck pain. These could be a sign that you have a severe injury, and that could cause long-term problems if left untreated. They could also point to a serious neurological condition.
If you’re having back or neck pain, see a physician immediately if you also start having pain that shoots down your arms or legs, or numbness or tingling in your spine, arms, or legs.
Also, see the doctor as soon as possible if you notice back or neck pain in combination with fever or night sweats, or bowel or bladder incontinence. It’s very important that you get these conditions looked at right away, as these symptoms could be signs of a more serious problem.