Chronic pain affects over 100 million people in America each year. We define chronic pain as pain that lasts for months, and even years in some cases. Many chronic pains can be traced to previous injury areas, certain medical conditions, and in some cases no root problem can be traced at all. Physical therapists play a vital role in the management of various chronic pains, keeping patients from turning to the more mainstream use of pain medications, or opioids, to manage ongoing pain.

Did You Know? The American Academy of Pain Medicine found that painkilling prescription medications, on average, helps only 58% of patients with chronic pain.

One of the more common chronic pain ailments is back pain. Physical therapists use many passive and active techniques to help strengthen and increase flexibility in those problem areas to alleviate ongoing chronic back pain. We polled several professional physical therapists, and compiled a list of the top 5 techniques physical therapists use to treat chronic back pain. Here they are:

1. TENS Unit

Transcutaneous Electrical Nerve Stimulators, or the more commonly known TENS Unit, can be used in and outside of physical therapy sessions to aid in temporary relief of ongoing back pain. The use of a TENS unit is a passive therapy method that uses targeted, but gentle and harmless, high frequency electrical impulses to relax areas of pain and discomfort. Physical therapists generally pair the use of a TENS unit with other, more active treatments for back pain with patients. The belief is that it relaxes problem areas to create a more natural feel and calm the areas for more curative treatments.
The use of a TENS unit is NOT a cure, but can be used for temporary pain relief for many hours. This pain free window can aid in the administration of active physical therapy treatments that will have more long term healing effects.

2. Heat or Ice? That is the question…

The age old question for using heat or ice is, “WHEN DO I USE HEAT OR ICE?” Regulating temperature around an injury area is an extremely important tool in the physical therapists arsenal. Here’s your answer…

Cold Therapy

Applying ice is the first line of defense when dealing with a swollen or inflamed area. Whether it be a fresh injury or post-surgical injury area, icing the area is the answer. Cold therapy constricts blood vessels allowing for the decrease of inflammation in those often swollen soft tissue areas, and aiding in healing.

Heat Therapy

Heat is to be used in cases involving muscular spasm and tightness in the affected areas. In these cases, heat is shown to decrease pain and aid in mobility in your areas tightening muscles, tendons, and ligaments. Using heat during a physical therapy session can make the affected areas more pliable and aid the therapist in stretching exercises. Though using heat is a great tool in many cases, it should not be a main focus of treatment.

3. Stretching

Though this may seem like an obvious choice, proper stretching technique is critical to any back injury or pain rehabilitation. Consulting a physical therapist about proper stretching is especially important when it comes to back pain. The back is a big area, and has many components, so there are a myriad of stretching techniques used when combating back pain. Here are just a few…

Neck and Shoulder Pain

The Flexion, or chin to chest stretch, is achieved by sitting or standing up straight and gently bringing your chin in a motion toward your chest, until the stretch is felt in your middle back neck area. The Lateral Flexion, or ear to shoulder stretch, is achieved similarly, but instead, gently moving your ear in a motion toward your shoulder until the stretch is felt in your side neck.

Middle and Lower Back

For middle and lower back stretching, consider the Back Flexion Exercise. Simply lie flat on your back and pull both knees up and toward your chest with your hands gently until you feel the stretch in your affected area.

Did You Know? More than 100 million Americans suffer from chronic pain at a cost of around $600 billion a year in medical treatments and lost productivity, according to a report from the Institute of Medicine (IOM).

4. Patient Education

One of the cornerstones of any good physical therapist’s practice, and especially when it comes to chronic pain management, is patient education on pain neuroscience. Most patients tend to have a poor understanding regarding the physiology of pain. The general assumption is that any pain equates to harm occurring to the patient, which leads to them becoming fearful of the activity. A patient may have maladaptive thoughts regarding the extent of their injury as well as the origin of their pain. Making patients aware of the cognitive-emotional characteristics that are commonly seen with chronic pain (fear-avoidance beliefs, kinesiophobia, catastrophizing, etc.) and giving them strategies to address these will give them the power to make positive changes toward the road of recovery.

5. Strengthening Exercises

Much like stretching, strengthening exercises are a part of “active” physical therapy, and an important tool to aid in the relief of chronic back pain. Two well-known back exercises are “McKenzie” exercises and “Dynamic Lumbar Stabilization.” These are exercises often prescribed in physical therapy practices and can be used in tandem with one another. Here’s a little bit about each…

McKenzie Exercises

These exercises, named after a New Zealand physical therapist, puts into practice the idea of extending the spine to relieve pain from compromised disc space. Mckenzie exercises can be done either sitting or standing, and heavily rely on core muscle stabilization and arm motions to extend the spinal area. The focus of the exercises also discourages bending forward during treatment, as that can compress and undo the benefits of these types of strengthening exercises.

Dynamic Lumbar Stabilization

This exercise method depends on the physical therapist finding the patient’s neutral spine position, or most comfortable position. The therapist will then introduce exercises of the surrounding back muscles to teach the spine to sustain this comfortable position. This can be used in conjunction with the McKenzie exercises, but can be strenuous, which makes these, at times, not ideal for elderly patients.

If you or someone you know is suffering from chronic back pain, consider consulting a physical therapist. Learn more about OPTA at

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