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Spine Physical Therapy

What is Physical Therapy?

Physical Therapy (PT) is a healthcare profession which deals with the rehabilitation of physical impairments and disabilities. The goal of physical therapy is to restore function. Specific to the spine, the goals are to improve mobility, lessen pain, and increase the overall ability of the patient to function.

What is a Physical Therapist?

A physical therapist is a health care professional who has been formally trained in this specialty by a College of Physical Therapy.

Here are the different levels of Physical Therapists:

  1. DPT

This stands for “Doctor of Physical Therapy”. It is a doctorate degree and the highest level of Physical Therapist. The education typically includes 4 years of college and 3 years of formal Physical Therapy education in a College of Physical Therapy.

       2. MPT

This stands for “Master’s in Physical Therapy”. The education typically involves 4 years of college and 2 years of formal education by a College of Physical Therapy.

       3. PTA

This stands for “Physical Therapy Assistant”. The education typically involves a 2 year Associate’s degree which includes formal education in Physical Therapy.

Why should patients who have suffered an injury or have undergone spine surgery have Physical Therapy?

Spinal injuries and spinal surgeries often cause pain which can result in loss of spine motion, strength and balance. Pain prevents the spine from functioning normally. Since the spine is an intricate organ which has many parts such as the vertebrae, muscles, tendons, ligaments and other supporting tissues, an imbalance in any of these components can lead to further loss of overall spine function. Rehabilitating the spine through Physical Therapy can allow patients to return to normal function quicker and safer preventing further injury or a longer recovery process.

What kind of treatments can a Physical Therapists offer?

Physical therapists can offer Active and passive treatments, which are often combined for maximum overall benefit.

  1. Active Treatments

Active treatments are activities which require the patient to participate. Examples are certain exercises of the spine or aquatic therapy.

      2. Passive Treatments

Passive treatments are activities where the patient does not have to perform any activities. These can be a manual therapy such as traction, or heat and cold packs which are applied to the spine.

Patients are often cautioned not to rely on passive treatments alone, but combine them with the active exercises the Physical Therapists prescribe for them.

Here are some of the active and passive treatments you might be offered when going to PT:

  1. Manual Therapy

Manual Therapy is the hands-on manipulation and mobilization of tissues, muscles, fascia, and joints to promote the mobility and health of the spine. When the spine hurts, patients do not move as well. This can lead to muscle tension and decreased mobility. Here are some examples of how Manual Therapy can help:

      2. Deep Tissue Massage:

Deep Tissue Massage focuses on treating the deeper muscles and tissues of the spine. Some of the techniques used are similar to Massage Therapy, however this technique is typically slower and deeper. Deep tissue massage treats adhesions which have formed between the muscles and other tissue from the chronic inflammation and lack of movement of the spine muscles.

      3. Myofascial Release (Soft Tissue Mobilization):

This is a technique where the restrictions of the muscle and fascia are gently lowered to allow for proper movement. This lowers muscle tone and tightness.

      4. Joint Mobilization:

Joint Mobilization means the Physical Therapist uses controlled motion to move a joint. It mobilizes a restricted spine joint and improves the function.

      5. Strain/Counterstrain:

This is a technique where the patient is passively moved away from the painful position of the spine. Stretching the spine in the opposite direction of the painful position can release tension. It also allows the brain to reset the tone of the muscle.

      6. Muscle Energy Technique (MET):

The patient is asked to initiate a certain movement of the spine which is then resisted. This allows for muscle mobility and improved joint function.

      7. Traction

Traction is the use of a certain position, gravity or a mechanical device to relieve compression of a part of the spine. This can help with tight spinal muscles, giving them a rest period. It may also relieve spinal nerve compression by separating the vertebrae, which provides more room for the spinal nerves. The force of the body’s weight on the disc can also be lessened, relieving the compression of a disc.

Traction can be applied manually or mechanically.

  1. Manual traction is done by the Physical Therapists using gentle hand-generated traction of the spine. Commonly the head is positioned and gently pulled away from the torso to stretch the neck.
  2. Mechanical traction is done with the help of devices, rather than by hand. A mechanical device applies gentle force to the spine to pull the vertebrae apart (distraction). There are numerous mechanical traction devices. Here are some examples:
  3. Spinal Decompression Tables are also commonly used by Physical Therapists.
  4. Over-door cervical traction devices use a soft head “halter” and a rope and pulley system to provide the traction. The amount of traction can be controlled either with weights or by hand. These devices can be used for at-home therapy.
  5. Pneumatic Cervical devices use an inflatable collar. As the collar is slowly inflated, it increases the distance between the head, and the chest and shoulders. This provides gentle and incremental traction of the neck. These devices are available for at-home therapy.
  6. Lumbar Traction tables provide mechanical traction to a patient who is secured on their back. A belt around the waist is attached to a traction cable which goes to the foot of the table. This cable can be attached to weights or a mechanical machine which provides preprogrammed traction.


      8. Spine Exercises

a. Stretching/Range of Motion

Proper stretching techniques are often combined with active exercises. This helps the spine maintain a normal range of motion and prevents loss of muscle mass from underuse (atrophy). Patients are taught to adapt a specific stretching routine which is designed for their specific spine issues. Flexibility exercises can help maximize the stretching of the muscle groups.

Spine patients are often taught to stretch the following muscle groups slowly and gradually:

  1. Low back
  2. Abdominal
  3. Legs
  4. Hips

b. Core Strengthening

The spine uses two specific muscle groups which give it stability and “core strength” during our daily activities. These muscles essentially build a “belt of muscles’ around our spine which supports it and takes some of the “work-load” away from the spine. Less “work-load” means less wear and tear on the discs and joints of the spine.

The “belt of muscles” are the deepest muscles of the back (Multifidus) and abdomen (Transverse Abdominus). These muscles require retraining and strengthening exercises in patients with low back pain. Again, these muscles are the:

  1. Multifidus Muscle
  2. Transverse Abdominus Muscle

Retraining these muscles will provide better control over the muscles and movement, which allows for better balance, and use of the spine muscles and joints. This lowers the force on the spine joints which can help with inflammation and pain from the discs and facet joints.

 c. Specific exercises for the core are:

  1. Pelvic tilts
  2. Crunches
  3. Leg Raises
  4. Abdominal Machines
  5. Spinal extension exercises


d. Stabilization/Coordination Exercises

Dynamic stabilization techniques taught by Physical Therapists can use balancing machines, exercise balls, or specific exercise techniques to stabilize the spine. Dynamic stabilization helps strengthening the secondary support muscles of the spine.


e. Low impact conditioning

Following the completion of basic spine exercises patients are often encouraged to advance towards a low impact spinal conditioning program. This can include some of these activities:

  1. Aerobics
  2. Yoga, Pilates, Tai Chi
  3. Jogging
  4. Stationary bicycling
  5. Swimming


Here are some of the reasons this can be beneficial:

  • Can prevent re-injury
  • Can prevent return of spine pain
  • Can help with conditioning for sports and recreational activities
  • Beneficial for overall medical health


f. Education

  1. McKenzie Method
    • Started by Robin McKenzie, famous Physical Therapist
    • The treatment starts with a specific diagnosis of the spine
    • The focus is on extension exercises
    • The McKenzie program is an actual treatment algorithm
    • The patients are also educated on proper spine health
    • Proper posture is emphasized and taught through exercises
  2. Body Mechanics                                                                     Lifting techniques are explained in detail and practiced                Ergonomics of how to modify the work environment to be “spine friendly” can be taught

g. Repex Table

This is an automated table which a patient lies on. A Physical Therapist can program the table to deliver a specific motion and cycles of treatment. The table automatically delivers the motion and exercises to the patient.

h. Heat and Ice

          Heat and ice are often used in an alternating fashion

  1. Can be used before exercises or treatments
  2. Heat helps with muscle spasms, increases blood flow and oxygen to the muscle
  3. Cold can soothe injured areas, quieting inflammation of muscle and tissue

i. Ultrasound

1. uses sound-waves to produce gentle heat in muscles and other tissues

2. Heat from the ultrasound stimulates blood flow and oxygen to help repair injuries

3. Can penetrate up to 2 inches deep into muscle

j. Iontophoresis

  1. Uses a machine which delivers small electrical impulses to deliver a medication through the skin.
  2. Takes advantage of the chemical charge of a medication to deliver it through the skin
  3. Is similar to injecting medication under the skin but does not use a needle
  4. Most common medications delivered by Iontophoresis are anti-inflammatory medications, including small doses of steroids.
  5. Especially useful when a small area of the spine needs treatment


  1. Uses Ultrasound to deliver medications through the skin
  2. Anti-inflammatory medications including steroids can be delivered


  1. Stands for “Transcutanous (through the skin) Electrical Nerve Stimulation”
  2. Electrical impulses are sent to small nerves under the skin
  3. The electrical impulses can increase chemicals which help with pain and spasms
  4. Small patches (electrodes) are placed on the skin which are hooked up to the TENS machine with electrical wires.
  5. TENS units are usually portable and can be worn like a “Walkman”.

m. Electrical Muscle Stimulation (E-Stim)

  1. Has been used since the 1940’s
  2. Electrodes are placed over the muscle and electrical stimulation applied
  3. Similar to TENS, but targets the muscles primarily
  4. Can help with muscle spasms and muscle irritability

n. Aquatic Therapy

  1. Warm water therapy can help relax muscles
  2. The body weight in water is exposed to minimal gravity, making some exercises easier to perform
  3. Some patients (elderly, disabled) can only exercise in water due to the minimal gravitational forces
  4. Water exercises are against force which helps conditioning
  5. Vibration of the water against the spine can help with spasm
  6. Improves range of motion

o. Hydrotherapy

  1. Involves being immersed in warm or hot water
  2. Often uses whirlpools
  3. Helps control muscle spasticity
  4. Promotes healing

p. Cold Laser Treatment (LLLT)

  1. One of the newest Physical Therapy modalities
  2. Potentially treats the spine at the cellular level to stimulate healing
  3. Does not use heat like “hot” Lasers
  4. May be specifically useful for Trigger Points


How long should I go to Physical Therapy for?

Physical Therapists will tailor a program for each patient, depending on the spine condition.

Often treatments are given over 4-6 weeks to make a significant difference. Patients can also be taught home programs to continue in their recovery.

How do I know it is safe to return to work?

Following an injury or surgery, patients often wonder when they should resume their usual activities at work. Once the pain lessens, the Physical Therapists often design a specific exercise program for their patient’s specific needs. This is typically designed towards the specific work requirements.

A “can also be used by the Therapists. These programs are meant to bridge the gap between where a patient’s current functioning is and where it should be to resume their work activities. The types of movements and forces encountered at work are simulated by the “work hardening” program. This is increased incrementally to avoid further injury. Patients are conditioned to be able to carry out the physical duties of their work environment.

Functional Capacity Evaluations are sometimes done to find out what a patient’s capabilities are and if they have limitations for work. This is done after the benefits of the Physical Therapy have been maximized, yet the patient is not able to meet the physical demands of their work environment. The outcome of the Functional Capacity Evaluation may be that the patient is unable to perform their work duties or has to have certain limitations in place.


Why do some patients fail Physical Therapy?

Here are some common reasons why some patients fail a course of Physical Therapy:

  1. Patients rely too much on the passive treatments (e.g. heat/cold packs, massage, etc.) rather than combining them with active exercises
  2. Patient’s exercise incorrectly. It is important to provide feedback about the prescribed exercises to the Physical Therapist who can explain them better and modify them if needed.
  3. Patients do not follow through on the prescribed exercises. Patients often get discouraged by experiencing pain during exercising or not seeing the benefit quickly enough. Patience and perseverance combined with the encouragement and coaching by the Physical Therapists can lead to success.
  4. Patients do not continue the exercises after the initial course of PT. Many patients will stop what helped them once they feel better. However spine problems tend to recur and often require an ongoing exercise program to maintain a fit spine.


What happens if I do not get better from Physical Therapy?

The spine specialist who referred a patient to Physical Therapy (PT) often has specific goals in mind. If they cannot be met by PT, other modalities are often used to make progress. These can consist of medications, spinal injections, or even surgery.