When you’re suffering from back or neck pain, it may be tempting to stay on the couch all day. But that’s a prescription for more pain. Although getting up and moving might be the last thing you feel like doing, physical therapy and exercise can be the best way to reduce pain.

Always talk with your doctor and get his approval before beginning a physical therapy or exercise program. That said, if you’ve gotten a green light, the first thing to do is get some information.

Q&A about physical therapy

Alexis Tingan, MD, Certificate of Added Qualification in Sports Medicine (CAQSM), physician at Penn Medicine, explains why physical therapy is important, and how you can exercise to relieve pain in the back or neck.

What is the best type of exercise to do for spine or back pain?

Alexis Tingan, MD, Certificate of Added Qualification in Sports Medicine (CAQSM): Whether you’re in physical therapy or not, you should try aerobic activity. Exercises like jogging, walking, using the stationary bike—these are all light aerobic activities that have been shown to decrease back pain. We’ve actually been doing some studies on this here at Penn, and we’ve seen promising results.

But when it comes to specific exercises or intensity of the exercise, that’s very individualized. What’s helpful for one person may make someone else’s back or neck hurt more. A physical therapist can help you find the exercises that are right for you.

Is there anything you shouldn’t do if you have pain in the spine or back?

Dr. Tingan: This is also different for each patient, but there are a few rules of thumb. The overarching theme is to not do any exercise that is painful. Physical therapy should be relieving pain, not causing more. It should not be causing any harm.

It’s also important for people with back or neck pain in certain areas to avoid actions that will make that particular type of pain worse.

What are some examples of that?

Dr. Tingan: Most of the people I see have back pain related to a problem with a disc, like one that’s herniated (slipped out of place). These patients usually have the most pain when they’re bending forward, especially in the morning. The disc isn’t ready to absorb the force or weight of bending over just yet.

So, I tell patients with disc problems to avoid exercises or activities that involve bending forward at the waist or twisting for at least the first 45 minutes of the morning.

If you are still struggling with back and neck pain, Penn Medicine offers an online assessment test to help you learn when it is time to see a doctor for the pain. 

Online Back and Neck Health Assessment Test

If a patient doesn’t want to do physical therapy, are there other treatment options?

Dr. Tingan: We do have medications, certain injections, and, in some cases, surgeries. But these are usually offered alongside physical therapy, because physical therapy is one of the most important treatments.

Do patients need to see a physical therapist, or can they just do exercises at home?

Dr. Tingan: I always recommend going to therapy, for three reasons.

The first is distraction. It’s easy to say you’re going to exercise for an hour. But then the phone rings, something happens at the house, you get busy—and you get in half an hour, or don’t do it at all.

Therapy is an hour of unobstructed time, with nothing to distract you from healing your body. And if you’ve already made an appointment, you will feel more obligated to go.

The second is the mechanics of the exercises themselves. It can be difficult to do the exercises on your own, and certain ones can cause more pain if they’re not done the right way. A therapist can observe you, and make sure you’re doing everything correctly.

Finally, physical therapy isn’t just a place to get better—it’s also a place to get educated. You won’t be in therapy forever, but therapy will provide you with exercises that you can take home and incorporate into your regimen indefinitely.

Is physical therapy more important for certain types of back pain?

Dr. Tingan: There are two general categories of back pain. Acute back pain—which comes on suddenly—can have many different diagnoses. It can be as benign as a muscle strain, to as serious as a severe spinal cord injury. The treatment is really dictated by the exact diagnosis.

The other category is chronic back or neck pain. Usually, that doesn’t have an acute cause. It’s more due to wear-and-tear changes, like a degenerated disc.

Even though there are different types of back and neck pain, we recommend physical therapy for both acute and chronic back or neck pain, so long as the acute pain does not require immediate medical or surgical intervention.

But even though it’s important for both types, it sometimes works a bit better for acute back or neck pain. Acute pain is easier to treat in general—most patients feel about 80 to 90% better after 6 weeks.

How do you determine the best types of exercises for each patient?

Dr. Tingan: One of the most popular methods physical therapists use is the McKenzie method. It assesses how pain affects a patient when he moves certain ways, like flexing forward or extending backward. It tests which movements worsen or improve the back or neck pain.

Using these results, we can determine strengthening exercises, so that these movements don’t cause as much pain.

If physical therapy doesn’t seem to be helping, does that mean the injury is more serious?

Dr. Tingan: Not necessarily, but it could mean that you need another form of treatment. If you have persistent back pain for 3 to 4 weeks despite exercising, see a physician.

Whether or not you’re in physical therapy, you need to see a physician if you notice other symptoms along with back pain. These could be a sign that you have a severe injury, and that could cause long-term problems if it’s left untreated. They could also point to a serious neurological condition.

If you’re having back or neck pain, see a physician immediately if you also start having symptoms like pain that shoots down your arms or legs, or numbness or tingling in your spine, arms, or legs.

Also, see the doctor if you notice back or neck pain in combination with fever or night sweats, or bowel or bladder incontinence. It’s very important that you get these conditions looked at right away.