There are many different structures in the back and neck that are capable of producing pain. There are the large nerve roots that go to the legs and smaller nerves that supply the nerves to the spine itself. The large paired back muscles may be strained, and the bones, ligaments and joints may be injured.

If an episode of low back pain last between two and six weeks, or if there are frequent recurrences of low back pain, it is reasonable to consider physical therapy as a possible treatment. In general, the goals of physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.

Physical Therapy

There are an immense variety of noninvasive non-drug techniques that physical therapist use for treating back pain. Acutely, the therapist may focus on decreasing pain with passive physical therapy or noninvasive non-drug techniques. A few of the most widely accepted examples of passive physical therapy include:

• Ultrasound - A form of deep heating in which sound waves are applied to the skin and penetrate into the soft tissues.
  
• Iontophoresis - A means of delivering steroids through the skin.
  
• TENS units - A transcutaneous electrical nerve stimulator unit which uses electrical stimulation to modulate the sensation of low back pain by overriding the painful signals that are sent to the brain.
  
• Heat/ice packs
  

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In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine.

On the other hand, invasive techniques involve invasion of instruments and devices into the body. However, pain management should be distinguished from surgery, which involves a greater degree of surgical insult and permanent alteration of tissue than other invasive techniques. A multitude of invasive therapies have been used to treat neck and back pain. Some of the most popular include:

• Surgically implanted electrotherapy devices-implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators. Clinical data offers inconclusive findings on the effectiveness of SCS.
  
• Injections-direct delivery of steroids or anesthetic to nerve, joint or epidural space. Injections into the facet, peripheral nerve, "trigger point" and other locations are also known as "blocks". These may provide relief of pain (often temporary) and can be used to confirm diagnosis. Epidural injections provide temporary relief for severe back pain.
  
• Radiofrequency radioablation-deadening of painful nerve via heat produced by a specialized device. The efficacy of this treatment is mixed.
  
• Prolotherapy-injection of solution to stimulate blood circulation and ligament repair at affected site. The effectiveness of this technique is not known.
  
• Implantable opioid infusion pumps-surgically implanted pumps that deliver opioid agents directly to the affected nerve. The appropriateness and effectiveness of these devices for treating chronic back pain is controversial.

There are some effective coping strategies that may help for continual chronic back pain. Of course, the first step in coping with back pain is to receive a medical evaluation to determine the cause of the pain.

Generally, conditioning through low-impact aerobic exercise is very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to gradually lose their ability to perform everyday activities.

Depending on your injury and exercise preferences, you may prefer a different form of exercise. It may be helpful to discuss your options with your physical therapist, or physician to identify an appropriate form of aerobic exercise for you and incorporate it into your exercise routine.

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