Low back pain is a common and often debilitating problem. The pain is often short-lived, and in some cases it resolves on its own, but many people need treatment to find relief. Physical therapy can be an effective, practical solution that helps people avoid surgery or long-term use of medication.

Physical therapists follow research-backed treatment guidelines and make treatment decisions together with their patients. Current research suggests that a combination of exercise, manual therapy and patient education is the preferred way to treat low back pain, particularly when the pain keeps coming back (1, 2).

How Can Physical Therapists Help?

Devise an Exercise Plan

A physical therapist can recommend the exercises that are safest and most effective for the type of pain you’re having. Exercises can be done during physical therapy appointments and as part of a home exercise program. For pain that has lasted less than 3 months, exercises that target the back or abdominal muscles may be most helpful. These exercises isolate the muscles that control and stabilize the spine.

Image spot (optional): core stabilization exercise

When pain lasts longer than 3 months, general exercise such as strength training, aerobic exercise and aquatic exercise often helps relieve low back pain.

• Strength training uses weights to improve how specific muscles perform.
• Aerobic exercise uses large muscle groups and gets your heart rate up, such as running, walking or cycling.
• Aquatic exercise takes place in a pool. It is a highly effective, low-impact alternative to traditional exercise that reduces pressure on bones and joints, while the water’s natural resistance still strengthens muscles.

Pilates-based physical therapy has grown in popularity in recent years. Pilates-trained physical therapists combine the targeted and general exercises that define Pilates with their knowledge of low back pain. This combination can help people with both acute (recent) and chronic (long-term) low back pain.

Manual Therapy

Physical therapists use manual therapy techniques such as massage and joint or soft tissue mobilization. Manual therapy helps reduce pain, which lets patients exercise with fewer restrictions and makes daily activities easier.

Soft tissue mobilization includes massage techniques and myofascial release. Fascia is a layer of tissue over the muscles that can become stiff, restricting movement and adding to pain. Myofascial release addresses the stiffness that commonly comes with low back pain.

Joint mobilization is a technique in which a therapist moves a joint by hand. It can improve joint mobility and reduce pain. Physical therapists tailor these mobilizations to each patient, and they can be directed at the vertebrae to help relieve back pain.

Image spot (optional): therapist performing hands-on manual therapy

Provide Patient Education

An important part of a physical therapist’s role in managing low back pain is helping patients understand pain itself. Pain science has evolved in recent years, and studies show that physical therapy combined with pain science education can be especially helpful for chronic low back pain. Teaching patients good posture and positioning, such as how to sit at a desk or lift an object from the floor, can help ease pain or keep it from coming back.

This article is for general education and isn’t a diagnosis or a substitute for care from a licensed provider. If your symptoms last or get worse, see a physical therapist or your doctor.