Early Physical Therapy Can Ease Lower Back Pain and Potentially Reduce Healthcare Costs
The National Institute of Health (NIH) states that back pain is the second most common neurological ailment in the United Staes behind headaches. Back pain is the leading cause of job-related disability and time missed from work. Low back pain can also be an indicators of other underlying problems such as kidney stones or urinary track infection. If back pain becomes chronic, it is more difficult to fully recover, and recurrence of back pain is very high.
Most family physicians only prescribe physical therapy if back pain has been persistent over several weeks and over the counter pain relievers have not been effective. Some family physicians would then order expensive tests such as x-rays or MRI’s to help them diagnose the problem and indicate whether referral to other specialists is necessary.
A better option is available! There is no need to delay physical therapy.
Physical therapists are highly trained to evaluate problems of the spine and surrounding soft tissues and neurological tissues. A physical therapist is able to diagnose the cause of the pain and the structures involved. Treatment of the underlying mechanical problems, including identifying imbalances in muscle strength and flexibility and joint restrictions, can help to effectively reduce pain and provide strategies to help the patient prevent recurrence. In addition, therapists are so skilled in their evaluation techniques that they will be able to tell you if further testing is required and will work with you to get the referrals you need.
Julie Fritz, PT at the University of Utah performed a study of 2,184 patients who visited primary care physicians between 2004 and 2008 to determine which course of treatment was most cost-effective (see footnote). 286 of those patients received physical therapy services within 14 days of the onset of their symptoms. These patient’s costs were compared with those who underwent other forms of treatment. The healthcare costs were on average $2,736.23 lower for the patients that received early physical therapy than those that received other forms of care.
If you have back pain it is worth it to see a physical therapist. Imagine the following scenario:
You wake up Monday morning after performing your fall yard clean-up, and you can hardly move. The day before you spent 3 hours raking and hauling leaves, trimmed some branches off the tree, and stacked some firewood. The pain in your back is excruciating. You expected to be sore, but not like this. You call your boss and tell him you threw your back out and won’t be in to work. You spend the day in bed and take an over the counter pain reliever. It works to take the edge off, and the next morning you go into work. After sitting at work for a couple hours your back starts to feel tight and uncomfortable, you have to keep moving around to keep it at bay. This goes on for another week. You wake up the following Monday morning and get ready for work. You bend over to pick your towel up and you get a shooting pain down the back of your leg and now it is difficult and painful to return to a standing position. You decide to call your doctor. He is able to work you into the schedule on Tuesday. He spends five minutes with you and tells you that you have sciatica. You leave with a prescription for an anti-inflammatory that you take for 2 weeks. It helps, but you finish the prescription and two days later the shooting pain is back and now your foot seems to be weak. You go back to your doctor and he says it is time for an MRI. It takes a week to get the MRI and to schedule a follow-up the with doctor for him to tell you the MRI shows a protruding disc. It is now 5 weeks since the initial morning you woke up with the pain. You have lost out on 6 days of work total for office visits and testing, not to mention you are still in pain and your work is suffering and your boss is starting to notice....Your doctor recommends a neurosurgical consultation and sets you up in another week for that appointment. By this time you can barely lift your foot up off the floor and it is constantly numb. The surgeon recommends surgery to clip the disc.....
The day you see your doctor you ask about physical therapy. He gives you the same anti-inflammatory prescription and a prescription for physical therapy. Your physical therapist is able to get you in the same day and evaluates your movement pattern in your spine along with your symptoms. She spends a whole hour with you discussing that the probable cause is a disc protrusion putting pressure on the nerve that travels down your leg, and that untreated it can lead to numbness and weakness in the foot. She gives you exercises to perform daily and sees you two more times that week for treatment. By the end of the week you are waking without back pain and can sit at work for longer without squirming. Another week of treatment and you are 90% better, and you have strategies to use for your posture in the car, lifting techniques, and sitting correctly at your desk to protect your back and prevent further injury. You are performing exercises to strengthen your core and the muscles surrounding your spine, as well as working on your flexibility in your hamstring. Within 3 weeks of beginning treatment you are pain free, performing your regular exercise routine, and have not missed any other days of work.
Which scenario sounds better to you? If the first scenario seems far fetched, let me assure you that it is actually very common. Delaying treatment of the initially minor complaint of back pain can result in further disability and costs, not to mention more time off of work, decreased quality time at home, and a higher risk of re-injury.
Your physical therapist can help you through early identification of the underlying problem, without expensive testing, give you the tools to manage your pain and improve your function, and help you to understand the nature of your problem so you can prevent recurrence. In many cases early treatment can help you avoid more costly testing and procedures, including surgery, and get you better more quickly without lost time, wages, or quality of life.
In Indiana you can now be evaluated and treated by your physical therapist without a prescription from your doctor. While your relationship with your primary physician is very important, you have options that allow for earlier intervention. Whether you visit your primary physician first, or choose physical therapy, your doctor and therapist can work together to establish the treatment plan and determine the best course of action for your specific problem.
If you have back pain, don’t wait! Contact a physical therapist today!
1. Fritz, Julie, John Childs, and et al. "Primary Care Referral of Patients With Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and Costs." Spine. Lippincott Williams & Wilkins, Inc., 26 Mar 2012.