PT considerations during management of the individual with a diagnosis of mechanical low back pain:
General physical therapy plan of care/goals: Decrease pain in rapid and cost-effective manner; begin graded, active, spinal activity program progressing to therapeutic exercise focused on enhancing neuromuscular performance
Physical therapy interventions: Spinal mobilization or manipulation to specific regions with primary intent of modulating pain; resistance exercises to increase muscular strength and endurance (especially of spinal extensors, abdominals, and hip musculature); exercises to improve motor control and overall aerobic fitness; education regarding position, loads, and activities that have the potential to exacerbate this specific clinical problem as determined by the pathomechanics gleaned via the physical examination
Precautions during physical therapy: No contraindications present for pain modulation techniques chosen; monitor that leg pain symptoms do not extend distal to the knee; exercise overload must remain within the physiologic limits of patient's spinal condition
Complications interfering with physical therapy: Psychosocial factors affecting prognosis including fear of movement and low expectation of recovery; exacerbation of pain following manipulation intervention; distal referral of symptoms as a result of manipulation or exercise regimen