A man grips his lower back in an outdoor setting.

Photo: Shutterstock

Your Back Hurts? There’s Physical Therapy for That

A Tufts expert explains the mechanics of back injuries and how they can be prevented and provides tips for healing

When physical therapist Kathryn Sawyer recently became one of the more than 600 million annual global back-pain sufferers, she was glad she knew how to treat her acute pain and what it would take to heal from an injury—but many are unfamiliar with what’s happening in and around the spine.

A photo of a woman wearing a black shirt, smiling at the camera.

Photo: Courtesy of Kathryn Sawyer

Sawyer is the director of clinical education for Tufts University School of Medicine’s Doctor of Physical Therapy program in Seattle and an assistant professor in the school’s Department of Rehabilitation Sciences.

Tufts Now chatted with Sawyer, whose 13-year practice primarily focused on spinal injuries and injury prevention, who hopes to share tips and tools to help people in a similar situation to her own. 

Tufts Now: We’ve all heard someone say, “I’ve thrown my back out.” What exactly is someone experiencing when this happens?

Kathryn Sawyer: When someone says they've "thrown their back out," they are typically describing a sudden, intense episode of low back pain, often accompanied by muscle spasms and limited mobility. This type of pain usually occurs in people who have some sort of underlying degeneration in their lumbar spine.

But when that happens, and when people experience a sudden onset of really severe pain, they can get very scared and many will go to the emergency room because they've never had pain that intense, but typically, the ER isn’t necessary, nor is imaging like an MRI.

If someone is in that type of intense lower back pain, what should they do?

Remain positive! Acute onset lower back pain has an overall favorable prognosis. People get scared because it hurts so bad that they just lie in bed, and that's one of the worst things someone can do. It sounds a little counterintuitive, but movement can be so helpful, and with the proper movement and care, it’s more than likely that things are going to get better in a few days. If they don't improve, then it’s wise to go see a physical therapist (PT), because we are trained to be able to screen for serious pathology. 

Heat and/or ice won’t change the course of events, but both can help temporarily relieve pain. Most people will use ice for acute pain and heat for chronic pain, but either one is fine. Over-the-counter anti-inflammatory medicine can also provide temporary relief, but we recommend people consult with their physician to make sure they understand the potential for side effects with the use of those medications.

Can you tell me more about those types of proper movements that someone should be doing to help themselves heal?

This would need to be individualized, and the nature of the injury taken into consideration. But there are wonderful ways to increase mobility and flexibility through dynamic movements and stretches, most of which can easily be done at home. PTs can evaluate a person and then put together a home program for them with written instructions, pictures, and even videos. A lot can be done at home. 

A woman squats on a mat in front of a couch.

"At home, it’s good for people to know that there are multiple ways to squat, and the form to use is the one that feels natural," said Kathryn Sawyer, the director of clinical education and an assistant professor for Tufts University School of Medicine’s Doctor of Physical Therapy program in Seattle. Photo: Shutterstock

That’s a great transition because I wanted to ask about movements that, on the flipside, could hurt someone’s back. My mind goes to squatting, and the mechanics of lifting with your legs rather than your back. What should someone be conscious of if they have to squat to lift something at home? 

I love squats. I know there’s some fear out there and people hear “squats are bad for your knees!” or “you’ll hurt your back,” and people miss out on what is actually a great, compound strengthening exercise that involves several muscle groups. Plus, it’s a functional movement. At the gym, people do need some basic weightlifting knowledge and technique to perform a squat correctly. Personal trainers and physical therapists can help here.

At home, it’s good for people to know that there are multiple ways to squat, and the form to use is the one that feels natural. For example, some people might want a wider stance to make them feel more stable and balanced. If someone has to squat to pick up or carry heavier loads, some general things to keep in mind: keep the load close to the body, maintain the natural curves in the back, and choose a stance width that is comfortable and feels stable—that might mean taking a wider stance or turning the feet slightly outward.

As PTs, we want people to move mindfully, not fearfully.

And what if they’re already experiencing pain?

If you’re already experiencing acute low back pain, you’ll generally want to avoid squatting, lifting, or anything strenuous until symptoms calm down.

How can someone’s mental state play into their healing?

When people become fearful and/or avoidant of certain types of movement, that can lead to more harm, or the potential for re-injury later on down the road. I think this is where PTs can truly help people: with education, reassurance, and guiding patients with exercise and activity in the presence of an injury, as well as immediately after.

What advice would you give someone who is seeing a physical therapist for the first time? What could they expect from a visit to treat a lower back injury?

The first thing is don’t be nervous—and to let the physical therapist know if that’s the case. The second would be to come prepared with a medical history and be prepared to talk about symptoms. Things that help a physical therapist with their assessment include knowing if there was an incident that brought on the symptoms, and if there are any movements or postures making things better or worse. There are a lot of questions that a PT will want to ask to try to dig a little bit deeper into what's going on. Usually, the first time someone sees a physical therapist, there’s a decent amount of talking and then some testing. We're probably going to want to look at things like range of motion, strength, how someone walks, sits, stands, and moves.

Posture! I’m hunching at my desk right now. I’m sure I’m not the only one who needs a reminder to sit or stand straight. If there are others like me, what should they know about working at a desk?

I know there is a common belief that “good” posture can prevent back pain. A lot of people would probably be surprised to know there’s a lack of evidence for a strong relationship between posture and back pain.

There is no single “perfect” posture, no one-size-fits-all way to sit or stand. You don’t need to worry about sitting up straight all day. You can relax and be comfortable. When I conducted ergonomic assessments for people who sat in front of a computer for 8 hours a day, here are a few things that were most frequently helpful for folks:

Thanks! I’m going to add those to my daily routine. Is there anything else someone should know if they’re considering working with a PT for back pain?

There's a lot physical therapists can do to teach people how to prevent things. If somebody were to come to me and say, “Here's what my job looks like. I also have a three-year-old to lift regularly, I sleep in this position, and I have these comorbidities,” I can take all of that and factor that into my assessment of that person and help put together a plan for them. 

If they want to feel better and heal, someone has to be prepared to put in the work beyond their appointments. Adhering to that home exercise program is important. If someone is seeking care, expect to get some homework. It’ll really help if they do it.

Doctor of Physical Therapy (DPT) students and faculty work through an exercise in front of a mirror.
Doctor of Physical Therapy (DPT) students and faculty in Phoenix. Photo: Caitlin O'Hara for Tufts University

Have you considered a career in physical therapy?

The School of Medicine currently offers an accelerated hybrid program in Boston, Seattle, and Phoenix. Find out how physical therapists are creating healthier communities with the education and skills honed at Tufts. 

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