If physical therapy is recommended, your physical therapist (PT) will start by asking you questions about your spine condition. You may be asked questions about when your pain started, where you hurt, and how your symptoms affect your daily activities. Your answers will help your PT focus on the source of your problem and what he or she will need to do to help relieve it. You PT will then likely do an exam that may include some or all of the following checks.

• Posture imbalances in the position of your spine can put pressure on sore joints, nerves, and muscles. Improving your posture can often make a big difference in relieving pain.
• Range of motion (ROM) measurements are taken of how far you can move in different directions. Your ROM is recorded to compare how much improvement you are making with each treatment.
• Nerve Tests your PT may check your reflexes, sensation, and strength. The results can help determine which area of the spine is causing problems and the types of treatment that will be best for you.
• Manual Exam your PT will carefully move your spine in different positions to make sure that the joints are moving smoothly at each level. Muscle and soft tissue flexibility is also tested.
• Ergonomics ergonomics involves where and how you do your work or hobby activities. By understanding your ergonomics, your PT can learn whether the way you do your activities may be making your pain worse. Sometimes even simple corrections can make a big difference in easing spine problems.
• Palpation your PT will feel the soft tissues around your spine to check for changes in temperature or texture, which may indicate that you have inflammation or nerve irritation. Palpation also checks whether there are tender points or spasms in the muscles near the spine.

Your PT will evaluate your answers and your exam results to decide the best way to help you. He or she will then write a plan of care, which lists the treatments to be used and the goals that you and your PT decide on to do your daily activities safely and with the least amount of discomfort. The plan also includes a prognosis, which is your PT's idea of how well the treatments will work and how long you will need therapy in order to get the most benefit.

To control pain and symptoms, your PT may recommend the following physical therapies:

• Rest resting painful joints and muscles helps calm soreness, giving your spine time to heal. If you are having pain with an activity or movement, it should be a signal that there is still irritation going on. You should try to avoid all movements and activities that increase the pain. In the early stages of your therapy, your doctor or PT may have you wear a brace to limit movement.
• Specific Rest specific rest allows safe movement of the joints and muscles on either side of a painful area while protecting the sore spot. If a brace was prescribed, you may be instructed to take it off a few times each day so you can do some gentle and controlled exercises.
• Positioning your PT will help you find positions for your spine that are most comfortable while sleeping or resting. He or she may also suggest positions to reduce stress on your spine while you are at work.
• Ice ice makes blood vessels constrict or get smaller, which decreases the blood flow. This helps control inflammation, muscle spasm, and pain.
• Heat heat makes blood vessels dilate or get larger, which increases the blood flow. This helps flush away chemicals that cause pain, and also helps bring in healing nutrients and oxygen.
• Ultrasound ultrasound uses high-frequency sound waves to reach sore muscles and other tissues that are over two inches below the surface of your skin. As the sound waves pass through your body they vibrate molecules, causing friction and warmth. This heating effect helps flush the sore area and brings in a new supply of blood that is rich in nutrients and oxygen.
• Electrical Stimulation electrical stimulation gently stimulates nerves as the current passes through pads applied on the skin. Some people say it feels like a massage on their skin. Electrical stimulation can ease pain by sending impulses to your brain that are felt instead of pain. Once the pain eases, muscles begin to relax, letting you move and exercise with less discomfort.
• Soft Tissue Massage PTs are trained in many different forms of soft tissue massage. Massage has been shown to reduce pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants that come from inflammation. Soft tissue massage can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease.
• Joint Mobilization your PT may apply changing pressures and movements to your joints to help lubricate joint surfaces. This will ease stiffness and help you begin moving with less pain. As your pain decreases, more vigorous pressures and movements may be used to lengthen tissues around the joint in order to restore better movement in your spine.
• Traction sore joints and muscles often feel better when traction (pull) is used. PTs apply traction with their hands or with a traction machine. There are also traction devices that you can use at home. The amount of pull that is needed will depend on your condition. A gentle on/off pressure may be better early on to help control arthritis pain. More vigorous traction can help take away pain if a spinal joint is mildly sore or tight.

PTs use functional training when you need help doing specific activities with greater ease and safety. Examples of functional training include:

• Posture healthy posture keeps your spine in safe alignment, reducing strain on the joints and soft tissues around your spine. The time and effort you take to use good posture are vital to spine care, and will help to prevent future spine problems. As you regain strength and control, proper posture and body alignment will be easier to remember and apply with all your activities.
• Body Mechanics think of body mechanics as putting safe posture into action. It is one thing to sit or stand with good posture, but another to keep safe posture as you actually move with activity. You want to keep your body in its safest alignment as you go about your daily tasks, such as getting out of a chair, taking out the trash, getting clothes out of the dryer, brushing your teeth, and lifting. Safe body movement is especially important during lifting. To avoid extra spine strain when lifting, use these safety tips:
  • Plan and prepare for the lift
  • Make sure you have good footing
  • Straddle your feet with a wide base of support
  • Keep the load close to your body
  • Keep your spine stable and aligned
  • Do not twist or pivot with your feet
• Ergonomics Ergonomics looks at the way people do an activity. It is possible that even minor changes in the way you do your work or hobby activities could keep your pain and symptoms in check, while protecting your spine from further injury. Ergonomics doesn't usually involve expensive changes. Even minor adjustments in the way you do your activities can make a huge difference in easing your pain and preventing further problems.

Once your pain is controlled, your range of motion has improved, and your strength is returning, you will be able to continue your physical therapy on your own at home. Your PT will review some of the ideas listed above to help take care of any soreness at home. You will be given instructions to help you keep working on your range of motion and strength. Before you are done with therapy, more measurements may be taken to see how well you are doing now compared to when you first started therapy.