Lower Back Pain: Understanding The Issues

This blog post was inspired by my colleague Brett Maxwell’s post and linked YouTube video by Dr Mike Evans.

That post and video presented excellent information about low back pain (LBP), and I want to take the opportunity to build upon that. The video indicates that most LBP gets better with time but some LBP becomes recurrent/episodic and some LBP unfortunately becomes chronic. The problem is that we cannot predict who’s LBP with resolve naturally with time and who’s LBP will become recurrent/episodic or chronic. What we do know is that early physical therapy (PT) intervention results a reduction in people’s LBP becoming chronic.

The Research:

1) A research report in Spine journal (Primary Care Referral of Patients with Low Back Pain to Physical Therapy: Impact on Future Healthcare Utilization and Costs by Julie Fritz, PT et al in May 2012 issue of Spine) concluded that early PT following a new primary care consultation was associated with reduced risk of subsequent healthcare compared with delayed PT. Read more here.

2) A second research report in Spine journal (Management Patterns in Acute Low Back Pain by Alfred Campbell Gelhorn, MD et al in volume 37/number 9 issue of 2012 Spine) concluded that there was a reduction of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. They also indicated that there was potential underutilization of PT by generalist/primary care medical doctors (MDs) so ask for a PT referral if you are consulting your medical doctor about your LBP. Read more here.

3) A third research report in Pain journal (A Controlled Study of the Effects of an Early Intervention on Acute Musculoskeletal Pain Problems by Steven Linton et al in March 1993 issue of Pain) concluded that early activation which included PT for “first-time” musculoskeletal pain resulted in decreased number of days off work and decreased risk for developing chronic problems. Read more here.

4) A fourth research report (Initial Management Decisions after a New Consultation for Low Back Pain: Implications of the Usage of Physical Therapy for Subsequent Health Care Costs and Utilization by Julie Fritz, PT et al in May 2013 Arch. Physical Rehabilitation) concluded that initial (early) PT management was not associated with increased health care costs or utilization. Read more here.

5) A final research report (Direct Access Compared with Referred Physical Therapy Episodes of Care: A Systemic Review by Heidi Ojha in January 2014 issue of Physical Therapy Journal) concluded that PT by way of direct access (not referred by MDs) may contain health care costs and promote high-quality health care.  It also concluded that third party payers (insurance companies) should consider paying for PT by direct access to decrease health care costs and incentivize optimal patient outcomes. PT services provided by directed access also did not result in harm.  Most insurances in Minnesota allow for direct access, but check with your insurance provider to make sure your PT services will be covered if you plan on seeking PT without seeing your medical doctor first. Read and download PDF here.
So with regard to the Dr Mike Evans video, PT should be considered early if you are having LBP.  Let PT be part of your “back resilience plan“. PT can help you recover faster and more completely from your mechanical LBP, back dominant pain, or leg dominant pain (sciatica or spinal stenosis) by helping you reduce pain, restore motion, restore strength, and restore function.  Additionally, PT can help you develop a plan to manage you back pain more independently if your back pain becomes recurrent/episodic.  Physical Therapist are also trained to recognize red flags and can help you determine the right course of action if your symptoms warrant medical doctor involvement or your symptoms are not appropriate for PT treatment. If you are already in the position of having chronic LBP, PT treatments which include education strategies (therapeutic neuroscience education is a chronic pain education concept that is utilized by OSI PT) can help you manage your chronic pain condition.

Physical Therapists provide manual therapy (joint and soft tissue mobilizations and manipulations), specific exercise (for pain control and spinal stabilization strengthening), education, and more generalized exercises which all have been proven effective in helping resolve LBP. Plus, PT can prevent your acute LBP from becoming chronic if we get involved in your care early enough.

Not all health care providers including PT’s have a good understanding of some of these issues so choose OSI PT for your back care needs.

– Steve