Why Should I See a Physical Therapist for Low Back Pain?

What is the prevalence of low back pain?

Low back pain is extremely common and the leading global cause of disability. Approximately 25% of the population has experienced low back pain in the past three months. It is estimated that 200 billion dollars are spent annually to manage low back pain.

Why is physical therapy a good first-line treatment for low back pain?

Early physical therapy utilization is associated with a reduced need for advanced imaging, additional physician visits, surgery, injections, and opioid medications. Medical costs for patients who received physical therapy were $2,736.23 lower compared to those who did not.

What will be included in the initial visit or examination?

A physical therapy examination typically takes about an hour and consists of discussing your medical history, symptoms, and experience with low back pain and then conducting a physical examination. The physical therapist will also assess your strength, range of motion, flexibility, and joint mobility to identify causes of pain and limitations in movement. After the examination, you will discuss the plan of care to improve your symptoms.

What are the typical treatments for low back pain?

Treatment for low back pain can include manual therapy, stretching, joint range of motion, patient education, motor control exercises, core strengthening exercises, and modalities such as TENS, heat, and ice. There is evidence to suggest that pilates, yoga, or a walking program can be effective in reducing acute and chronic low back pain. 14% of patients who sought care for low back pain were prescribed opioids despite a lack of evidence to support their efficacy.

What are the typical outcomes of physical therapy?

Physical therapy has been shown to reduce back pain as well as reduce recurrences. If symptoms do not improve with conservative intervention, referral to another provider is indicated.

Do I need an x-ray prior to coming to physical therapy?

Imaging is not typically recommended for 4-6 weeks following the onset of back pain. Early imaging is associated with worse outcomes due to the identification of small abnormalities in asymptomatic patients. With the exception of the following red flags:

• Severe or progressive neurological changes

• Changes in bowel and bladder function

• Numbness or tingling in the groin or tailbone

• Sudden back pain with spinal tenderness with a history of osteoporosis, cancer, steroid use

• Trauma

If you experience any of these symptoms, please follow up with your primary care provider or visit the emergency room immediately.

Do I need to see a doctor prior to coming to physical therapy?

No, physical therapists have direct access which means you do not need a physician’s referral prior to making an appointment. Physical therapists are trained to screen for red flags such as cancer, fractures, infection, or other serious conditions. During your evaluation, you can discuss any concerns with your physical therapist.

Why should I see a physical therapist when I could look up exercises on my own?

Having an assessment completed by a physical therapist will create a specialized treatment plan. Like people, backs are not the same so each person’s treatment plan and exercises should not be the same. Seeing a physical therapist will create a plan for your specific impairments and type of back pain.

References

Acute Low Back Pain | Acute Pain. (2020, May 11). CDC. Retrieved December 3, 2021, from https://www.cdc.gov/acute-pain/low-back-pain/#ftn1

Casiano VE, Dydyk AM, Varacallo M. Back Pain. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/

Cauda Equina Syndrome – Symptoms, Causes, Diagnosis and Treatments. (n.d.). American Association of Neurological Surgeons. Retrieved December 3, 2021, from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cauda-Equina-Syndrome

Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine (Phila Pa 1976). 2012;37(25):2114-2121. doi:10.1097/BRS.0b013e31825d32f5

Guide | Physical Therapy Guide to Low Back Pain. (n.d.). Choose PT. Retrieved December 3, 2021, from https://www.choosept.com/guide/physical-therapy-guide-low-back-pain

Low Back Pain. (n.d.). Physiopedia. Retrieved December 3, 2021, from https://www.physio-pedia.com/Low_Back_Pain#cite_note-:4-1

A Mechanism-Based Approach to Physical Therapist Management of Pain. (2018, April 16). NCBI. Retrieved December 3, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256939/

Miyamoto GC, Costa LO, Cabral CM. Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis. Braz J Phys Ther. 2013;17(6):517-532. doi:10.1590/S1413-35552012005000127

Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci. 2018;8:30. Published 2018 Aug 24. doi:10.4103/jcis.JCIS_16_18

Shipton EA. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther. 2018;7(2):127-137. doi:10.1007/s40122-018-0105-x

Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. Am Fam Physician. 2018;98(7):421-428.