Pain expert Dr. Scott Fishman answers questions about back pain:

Q: How does physical therapy relieve chronic back pain?

A: There is no easy answer to this question because there is no single type of physical therapy (PT). While some studies indicate that PT is not a miracle cure for acute low back pain, it can offer a world of benefits for those with chronic back pain. It also can prevent problems before they arise. Overall, PT seeks to increase function and improve quality of life for someone with back pain.

Rather than promising yet another "cure" that may fail, PT for chronic low back pain teaches patients how to manage their own pain. It offers ways to cope with pain, as well as techniques for patients to minimize the impact of pain on their lives. I believe that patients do best when they take control of their own condition and avoid over-focusing on a possible miracle cure or medical salvation.

One of the biggest obstacles to normal activity is disorganization. The lives of pain patients may become lost and unstructured. As a result, they don't pace themselves, either overdoing it when they feel good or becoming inert when they hurt. Their pain sidelines jobs, daily routines, social lives and hobbies. Thus, the centerpiece of PT is a program and schedule for managing pain while gradually returning to an active life.

Increasing function and improving quality of life through movement is the heart of PT. In the past, PT was seen as a side dish on the menu of pain treatments. Today, it is often the main entree. A physical therapist first will assess a patient's back pain and give a hands-on examination, looking for how pain has altered the person's gait, posture, sitting tolerance, flexibility, and muscle strength.

The therapist will get a good perspective on how the pain has affected overall health, attitude, and the patient's daily routine (such as the ability to carry groceries, walk, or do light housekeeping). This assessment provides a baseline from which the therapist can judge a patient's progress and control over his or her pain.

The therapist and patient together map out a program of activities designed to address each of the impairments caused by pain. These activities may include sitting with improved posture for a specified period of time each day and gradually increasing this time.

They may include icing the back a number of times during the day, walking a couple of times a day, and completing a series of hip flexion and pelvic exercises. A therapist may use traction to help improve low back motion, particularly when there are signs of disc degeneration. Traction is not necessarily a pain remedy or treatment but a way to ease back stress and enable a person to move more freely.

The best sign of the success of PT is a noticeable improvement in a patient's daily activities and the ability to reclaim a normal routine. Quick gains are not useful unless they persist. The key is to increase and improve activities gradually, so that there is not further damage and long-term success is achieved.