Physical Therapy

Overview

At the USC Center for Spinal Surgery, we take pride in recommending the most conservative approach to effectively treat a patient's spinal disorder. Physical therapy is a non-operative form of management that can aid in achieving and maintaining optimal health of a patient's spine and alleviating pain. Physical therapists are health care professionals skilled in the evaluation and treatment of spine-related disorders in the cervical, thoracic and lumbopelvic regions, which can be the result of previous injuries or degenerative conditions of the neuromusculoskeletal system. The neuromusculoskeletal system includes the spinal cord, spinal muscles, nerves, intervertebral discs, vertebrae (spine bones), facet joints, tendons and ligaments.

The USC Physical Therapy department provides top-level conservative treatment, and is consistently ranked as one of the best, if not the best, physical therapy programs in the United States. In addition, the USC Center for Spinal Surgery collaborates with many of the top physical therapy clinics throughout the entire Los Angeles and Orange County areas. Our broad interaction with these clinics allows us to locate a physical therapy provider that is well qualified and conveniently located close to home for our patients.

A referral to physical therapy will start off with an evaluation of a patient's current condition by a physical therapist. This process will include questions regarding a patient's current condition followed by physical tests and measurements. These are done to help identify or verify the source of the spine problem and to evaluate a patient's current level of strength, mobility, and flexibility. Following the evaluation, the therapist will explain the results with a recommendation of the best way to improve on the current condition. The parameters of pain, strength, mobility, and flexibility will continue to be measured and used to quantify a patient's improvement throughout the course of treatment.

A primary focus of Dr. Spoonamore's spine physical therapy rehabilitation program is spinal stabilization. Patient's are issued a program booklet and personally instructed by the therapist on abdominal, trunk, and back strengthening exercises. The goal is of spinal stabilization is to improve the strength, endurance, balance and control of these muscle groups, especially the transverses abdominis (abdomen) and multifidi (back). As patients strengthen their core and back muscles and improve their flexibility, more of the joint loading forces of the spine are stabilized by the muscles and there is less strain on the injured disc and ligaments, which generally leads to less inflammation and pain.

Patients are initially instructed on the basics of realizing a neutral, pain-free posture in the supine (laying down) position. The neutral position is somewhere between an arched back and a flat back. Patients are further instructed on a series of exercises in which the arms and/or legs are moved while the trunk, back, and pelvic muscles work hard to hold and maintain the spine in the neutral position. A variety of exercise positions are utilized including laying on the stomach, back, side, quadriped (on all fours-arms and legs), sitting, and standing. Patients are advised to perform the exercises daily or twice daily on their own at home, even when they do not visit the therapist. Exercises will be added to the regimen as indicated and as a patient's strength improves. Sport-specific exercises are incorporated for competitive athletes.

Physical therapy interventions may also include the use of specific hands-on techniques such as manual therapy or joint mobilization. Patients also receive instruction on behavior modification in regards to posture and body mechanics, which can help avoid re-injury. Modalities such as phonophoresis, iontophoresis, TENS, heat, ice, and/or electrical muscle stimulation can also play a role in reducing spinal inflammation and pain.

Overall, the goal of physical therapy is to identify and teach patients efficient management strategies to improve spine-related problems with an emphasis on decreasing current pain symptoms, improving strength and function, and minimizing recurrence of symptoms. Physical therapy, with or without other conservative treatments, can often be curative for spinal pain, as evidenced by the fact that less than 1% of patient's with neck or back problems ultimately go on to have a spinal surgery.

Selected Bibliography

Adams MA, May S, Freeman BJ: Effects of backward bending on lumbar intervertebral discs. Relevance to physical therapy treatments for low back pain. Spine 2000 Feb 15; 25(4): 431-7.

Batt ME, Todd C: Five facts and five concepts for rehabilitation of mechanical low back pain. Br J Sports Med 2000 Aug; 34(4): 261.

Borenstein D: Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol 1996 Mar; 8(2): 124-9.

Handa N, Yamamoto H, Tani T: The effect of trunk muscle exercises in patients over 40 years of age with chronic low back pain. J Orthop Sci 2000; 5(3): 210-6.

Hart LG, Deyo RA, Cherkin DC: Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine 1995 Jan 1; 20(1): 11-9.

McMorland G, Suter E: Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther 2000 Jun; 23(5): 307-11.

Pustaver MR: Mechanical low back pain: etiology and conservative management. J Manipulative Physiol Ther 1994 Jul-Aug; 17(6): 376-84.