Don't be puzzled by back pain: a physical therapist can determine the source of your back pain and help you alleviate it.

"Oh, my aching back." Chances are, you've uttered those words before or at least heard them from someone else. Fortunately, there are many effective options for treating back pain and preventing it from recurring. And your physical therapist can arm you with tools that can keep your back healthy and strong.

The back functions as the central link of a kinetic chain that includes the head, jaw, neck, upper back, shoulders, and arms at one end and the legs and feet at the other. Your back affects virtually every other part of the body, and so figuring out the source of back pain can be like solving a puzzle, says Michael Cibulka, PT, MHS, OCS, of Jefferson County Rehabilitation in Missouri and president of the Orthopaedic Section of the American Physical Therapy Association.

"The pain may develop for any number of reasons--a woman who repeatedly bends to set down and pick up a purse or a dentist who props up the same leg on a stool while he works can both increase their risk of low back pain," Cibulka says.

When people complain of a "bad back," they're usually talking about the lower back (lumbar region). And for good reason: Your low back bears the brunt of bending, stooping, sitting, and, especially, lifting.

While some back problems may arise as the result of a specific traumatic incident--a fall, sports injury, or car accident--many seem to develop out of nowhere. The culprit is often cumulative stress, strain, and abuse from years of poor posture and bad body mechanics. "Most of my patients have not had a major incident that causes their back pain," says Cibulka. "Impaired joint mobility, muscle weakness, and muscle inflexibility developed over a lifetime of poor posture, inactivity, or previous injury can build up until finally a minor movement sets off the pain."

A physical therapist is uniquely skilled to help you care for your back. Says Cibulka: "A physical therapist evaluates how all parts of the body interact. He or she knows what `normal' ranges are for movement, flexibility, and strength and can determine what parts of your body are working within or outside of those ranges. He or she also will ask about other factors such as your age, occupation, and recreational activities. These things are all pieces of the puzzle that form the whole patient. That's why it's so important to see a physical therapist for persistent back pain. He or she has the expertise to `solve the puzzle' of where the pain is coming from and can recommend the correct elements in your plan of care."

When addressing a particular back problem, a physical therapist has a wide range of strategies to draw upon. Depending on the physical therapist's examination, evaluation, and diagnosis, a back rehabilitation program almost certainly will incorporate strength, endurance, and flexibility exercises; manual therapy; attention to improved postural alignment, gait, and body mechanics; and weight management: It also may include heat, cold, massage, and traction if needed.

One key to successful management of back pain, says Cibulka, is treating it early: "The sooner a physical therapist can identify and correct the posture, habit, or behavior that contributes to your low back pain, the better your chances of relieving it with milder treatments or with simple, commonsense actions."

Take Care of Your Back

While you can't avoid every physically stressful activity, you can minimize the risk inherent in any activity by applying some simple principles:

Work on your posture. Don't slouch. Maintain the natural "arch" in your lower back whether standing or sitting.

Lift with your legs. Don't bend over the object--bend your legs and keep your back straight. And most important, don't twist as you lift!

Sit with care. Prolonged sitting in one position is a back hazard you might not suspect. Lumbar support and periodic breaks to move around are essential. Also, says Michael Cibulka, PT, MHS, OCS, take notice of habits that can lead to hip joint or muscle imbalance: Don't cross or sit on one leg more than the other. Make sure your feet rest on the floor.

Watch your posture when you sleep. Habitually pulling the same knee up to your chest can lead to hip muscle and joint imbalance, Cibulka says. A pillow under your knees can reduce flexibility of your thigh muscles.

Control your weight. Being overweight can put added stress on your lower back, not to mention the rest of your body.

Stay physically fit. Perhaps the most important factor in avoiding back injury may be your overall physical fitness. The better shape your body is in, the less susceptible you will be to injury, including injuries of the back.

Maintain healthy back muscles. Appropriate strength, endurance, and flexibility for your back can be achieved through a regular program of trunk stabilization and stretching exercises. When you have strong yet flexible back muscles, there is less stress on the bones, discs, and joints of the back.

Maintain healthy lower extremity muscles. Your pelvis, which forms the base of your lumbar spine, requires appropriate joint mobility, muscle strength, and flexibility in the muscles and joints of the hips, knees, and feet. Any kind of imbalance in the lower extremities may result in future low back pain.