Physical Therapy for Back Pain: How It Works, What to Expect, and Recommended Exercises

If your back is stiff, tight, achy, or just generally makes it tough to move through your daily life, please know that there are a lot of people out there who feel the same way. An estimated 80% of people will experience back pain at some point in their lives. And research shows that health care expenses related to low-back and neck pain are one of the costliest in the United States (outranked only by diabetes and heart disease).

But (and this is a very important but) even though back pain can be debilitating and frustrating, there’s a lot you can do to manage it. There’s good evidence that physical therapy helps alleviate and prevent back pain symptoms. In fact, it can be so effective that it’s recommended as a first-line treatment, before medication or expensive medical interventions, like imaging and surgery. You may have a mental image of physical therapy being only for an acute injury, like an ACL tear in the knee, or for recovery after surgery. But physical therapy and regular targeted exercises can be very effective for persistent back pain, whether the pain seems related to a specific injury or is chronically present.

Physical therapy is “treatment provided by a physical therapist or physical therapist assistant that helps people improve their movement and physical function, manage pain and other chronic conditions, and recover from and prevent injury and chronic disease,” according to the American Physical Therapy Association. Hinge Health offers access to physical therapy and much more. It’s a digital musculoskeletal clinic that helps people take control of their pain and other symptoms by providing physical therapy, exercise therapy, education, and health coaching, among other offerings. 

Here, we’ll explain how physical therapy is used to treat back pain and how Hinge Health can offer access to physical therapy and more. (To see if you qualify for the Hinge Health program, confirm coverage at no cost to you through your employer here.)

Back Pain Explained

"The vast majority of people with back pain have what we call non-specific back pain, which means that it could be related to a number of different issues, and likely a combination of them," says Dylan Peterson, PT, DPT, a Hinge Health physical therapist. These issues can be grouped into categories like physical, anatomical, lifestyle, and more.

• Physical issues include factors like current fitness levels, doing activities that require a lot of awkward bending and twisting, or habitually over-tensing back muscles.

• Anatomical issues include things like a disc bulge or changes in the joints, like arthritis. 

• Lifestyle issues include things like poor sleep, stressful life events, low physical activity, negative work relationships, avoidance of meaningful activities, and much more.

Back pain can be acute (defined as lasting less than 12 weeks) or chronic (lasting longer than 12 weeks). While all pain is due to some combination of factors, there is an increased risk of developing chronic low back when a variety of factors, not just tissue damage or injury, are stressing your pain system and body, including those discussed above.

How Can Physical Therapy Help My Back?

When your back hurts — and you feel achy or limited — there’s a tendency to want to just take it easy and stop your usual daily activities. It’s true that dialing back your movement a little for a period of time can sometimes be helpful. But taking a total hiatus from exercise isn’t the answer, says Dr. Peterson.

Activity can sometimes cause a temporary uptick in pain that can make some people worry if they’re causing any harm or making things worse, but that’s not usually the case. In fact, getting or staying active is often one of the best things you can do for back pain in the long run. “We now know that your pain can actually become worse with too much rest. Staying active can help you work through some of your stiffness and gain strength that makes your symptoms improve,” says Dr. Peterson. “In other words, not moving might be riskier than moving in spite of some pain.” 

You may not be able to control every issue involved in your back pain, but you do have the power to manage your symptoms and break the pain cycle.  

That’s where physical therapy can be incredibly helpful.  

Back Symptoms and Physical Therapy

Physical therapy is one of the first nonsurgical treatments providers recommend for most cases of back pain. Targeted exercises can help relieve pain while strengthening and stretching weakened or stiff muscles.

Physical therapy can help you manage a lot of different back pain symptoms, including: 

• Stiffness or soreness during the night or first thing in the morning

• Pain when bending, lifting, or even sitting and standing

• Tightness or soreness related to a new or repeated activity

• Weakness or numbness in your legs and/or feet

• Pain that radiates down your back into your legs (sciatica)

Back Conditions and Physical Therapy

Back pain may be related to many different conditions that can be effectively treated or managed with physical therapy. These include: 

• Arthritis

• Back sprains and strains

• Changes in the discs in your spine (a herniated disc, for example)

• Congenital spine conditions, such as scoliosis

• Myofascial pain

• Osteoporosis

• Spondylosis

• Spinal stenosis

• Inflammatory conditions, including ankylosing spondylitis

Whether back pain is primarily related to one of these conditions or something else, physical therapy can offer a lot of benefits for back pain and function. 

Goals of Physical Therapy for Back Pain

• Improving function. The primary goal of physical therapy is getting you back to doing the things you love — or even just being able to accomplish the daily activities you need to do with more ease and less pain. 

• Relieving pain. Physical therapists provide guidance on how to perform therapeutic exercises that are tailored for your needs and goals. Research shows that people with back pain who engage in PT report less pain, fewer missed days of work, and better overall quality of life.

• Possibly eliminating the need for medication or surgery. PT is considered the first-line treatment for back pain, and may reduce your need for drugs such as opioids or surgery.

• Increasing range of motion. Back pain can restrict your normal range of motion, leading to stiffness and limited mobility. Physical therapy focuses on restoring range of motion with targeted exercises and stretches. This helps loosen tight muscles, improve flexibility, and promote better joint movement.

• Strengthening and stabilizing core muscles. Muscles that have lost strength can contribute to back pain and instability. Physical therapists prescribe specific strengthening exercises to target the muscles that support your trunk. These exercises improve muscle strength, endurance, and stability. This reduces strain on your back and improves overall function.

• Providing education and self-management techniques. Physical therapists play a vital role in educating patients about their symptoms and conditions, providing self-management strategies and lifestyle changes, and empowering them to take an active role in their recovery. Physical therapists can help you make lifestyle modifications as needed and teach you how you can manage pain on your own (especially with movement and exercise) so you can keep making progress toward your goals. 

• Sharing prevention tips. Physical therapy isn’t just about managing current pain episodes. It’s also about equipping you with tools and knowledge to prevent future back pain flares and maintain a healthy back and body. Physical therapists may provide guidance on ongoing exercises, self-care strategies, and lifestyle modifications to minimize the risk of reinjury and promote long-term back health.

The goals and treatment approaches used in physical therapy will vary depending on your specific condition and needs. A thorough assessment by a qualified physical therapist will help determine the most appropriate treatment plan tailored to your unique situation.

Physical Therapy, Exercise Therapy for Lower Back Pain, and Hinge Health 

Physical therapy means you are getting treatment from a licensed physical therapist or physical therapy assistant. At Hinge Health, our members can see their own licensed physical therapist who personalizes and oversees their care plan. Hinge Health physical therapists focus on what we call exercise therapy, or therapeutic exercises.

Exercise therapy means following a treatment plan of different types of exercises to help relieve pain, improve function and mobility, recover from injuries, and manage chronic conditions. Many people associate “exercise” only with getting fit or losing weight. We at Hinge Health love the phrase exercise therapy because it speaks to one of our main treatment philosophies: Movement is medicine.

Exercise therapy and physical therapy are not interchangeable. Our physical therapists prescribe exercise therapy to our members. Following your own personalized exercise therapy routine is one of the best ways to heal your back pain and prevent it from recurring. 

Back Pain Recovery with Hinge Health

If you’re experiencing back pain that makes it hard to move freely, you can get relief with Hinge Health. A digital clinic for joint and muscle care, Hinge Health provides members with access to their own physical therapist, in addition to other program offerings (guided exercise therapy, personalized health coaching, education, and more). 

It can be very challenging to stay consistent in doing exercise therapy, but research shows that consistency is the best way to build a habit and maximize your results. Our physical therapists, health coaches, doctors, and other care team members all share a common goal of helping our members make exercise therapy a habit so they can get back to doing what they love.

Hinge Health physical therapists can give you an assessment and provide you with personalized recommendations to help you achieve your goals. Our physical therapists are trained to rule out any serious causes of your pain, modify your activities, empower you with tools to help you hurt less, and provide you with a personalized program to strengthen your body and help you recover.

Meeting with a Hinge Health Physical Therapist

Unlike many traditional physical therapy visits, you can meet with a Hinge Health physical therapist via video visit. That means, from the comfort of your own home, you can discuss your symptoms and goals with a physical therapist. They can conduct a movement assessment, observing how you move through different ranges of motion — and then create a personalized plan for you based on their findings. They can show you how to perform certain exercises and make sure you feel confident performing those movements on your own.

In addition to looking at your movement patterns and showing you how to do certain exercises, your video visit with a physical therapist provides you the opportunity to ask questions about your pain, function, and progress in the Hinge Health program. Your physical therapist can also make modifications to the exercises in your Hinge Health program to help you along the way to healing. 

Hinge Health's Proven Results and Effectiveness

Hinge Health members have access to a library of therapeutic exercises designed to help you overcome your back pain. This involves a combination of strengthening and stretching exercises. Your physical therapist can then tailor those exercises even further to better suit your needs and help you achieve your specific goals. 

We’ve published clinical studies with over 10,000 Hinge Health members, in collaboration with researchers at Stanford and the University of California, San Francisco. These show that our members experience, on average, a 68% reduction in pain in their first 12 weeks alone. Of course, beating pain has other benefits, too. These members experienced a 58% decrease in anxiety and depression on average over that same period.

Importance of Health Coaching 

Another facet of the Hinge Health program that sets it apart: personalized health coaching. In addition to having tailored exercises and access to a physical therapist, many Hinge Health members work with a health coach. Their job: to be your partner and support you on your Hinge Health journey.

“Often when people feel pain, their instinct is to limit the activities they do. But that can lead to weakness and stiffness that only adds to the cycle of pain,” says Dr. Peterson. Moving even when you have some amount of pain can be a beneficial way to improve mobility and promote healing of your back. And that’s where your Hinge Health coach can help. They’re experts at listening, reflecting, encouraging, and helping members get routines in place. They are helpful for accountability and for moving past obstacles and thinking through where to put a new habit into your life.

Your coach can share information and guidance on the exercises and education concepts in your program, help you stay motivated and accountable, celebrate your progress and support you in working through obstacles, and help you explore meaningful goals and ways to reach them. 

These exercises for lower back pain recommended by Hinge Health physical therapists help build lower body strength, flexibility, and mobility. These act as a good starting point, but you can also work with a physical therapist for more personalized guidance. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Dieleman, J. L., et al. (2016). US Spending on Personal Health Care and Public Health, 1996-2013. JAMA, vol. 316, no. 24, p. 2627. doi:10.1001/jama.2016.16885

2. Frogner, B. K., et al. (2018). Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Services Research, vol. 53, no. 6, pp. 4629–4646. doi:10.1111/1475-6773.12984

3. Zhang, S., et al. (2023). Effects of Exercise Therapy on Disability, Mobility, and Quality of Life in the Elderly with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Orthopaedic Surgery and Research, vol. 18, no. 1. doi:10.1186/s13018-023-03988-y

4. Back pain: In depth. (2022). National Institute of Arthritis and Musculoskeletal and Skin Diseases.. Retrieved from  https://www.niams.nih.gov/health-topics/back-pain/advanced

5. Low back pain: Fact sheet. (2020). National Institute of Neurological Disorders and Stroke. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet