Surgery and a cart full of drugs aren't the only solutions for back pain!
Low back pain is the second most common reason that people see a physician. (Colds and the flu are number one.) In some cases, back pain will resolve itself with time. Unfortunately, once someone has had an episode of low back pain, it tends to recur and can often become an ongoing problem. In 2006, more than ten percent of North Carolinians reported chronic low back pain.
From 1997 through 2005, health care costs for low back and neck pain increased dramatically. This would be okay if the increase in spending were met with an improvement in the condition, but such an improvement did not occur.
One reason for the rise in costs is due to the increased use of imaging studies, which are far from perfect. MRI’s on people without low back pain often show abnormalities. The New England Journal of Medicine reports the abnormalities found in people WITH low back pain may often be coincidental.
The early use of imaging studies to diagnose conditions may often mislead people into believing their problem is worse than it actually is. In turn, this belief may lead them to seek more invasive and expensive treatments when other less invasive, more economical treatments would sufﬁce. A positive correlation between those areas where physicians order the most spine images and where the most spine surgeries are performed supports this concern.
Physical therapy —an economical, non-invasive option
If we are looking to avoid expensive invasive procedures, what can we do for people with back pain? Multiple studies have shown that well-trained physical therapists can effectively manage patients for musculoskeletal conditions and correctly identify those who need to be referred to an orthopaedic surgeon. In fact, these studies show that physical therapy is a cost effective treatment that WORKS. Unfortunately, a recent study has shown that exercise and physical therapy, the most effective treatments, were under utilized, while narcotics and other medications were over utilized.
The overwhelming majority of low back pain cases are uncomplicated. Even those who have suffered from recurring episodes of back pain or have had surgery in the past are well served by seeing a physical therapist, and physical therapy should be in the frontlines of treatment.
All physical therapyis not created equal
A recent article in The New York Times highlighted an area of concern in the physical therapy profession. Many therapists provide passive treatments— such as heat, ice and electrical stimulation —that only bring about temporary relief of symptoms.
Take the time to learnabout the physical therapists in your area. What advanced training do they have? Do they help to empower patients to take an active role in their rehabilitation? Do they focus on you and your needs or are they spread thin running between multiple patients? Do you see the same therapist for each visit?
A good therapist uses a combination of education, exercise prescription and manual therapy. This speeds recovery and ultimately helps people to know how to be more active with less pain. Your physical therapist should be able to explain various treatment options along with their beneﬁts and risks, and the evidence for what will work. If your physical therapist cannot do this, you might want to rethink your choice of therapist.
When someone has lowback pain, their stomach and back muscles do not work properly to support the spine. Exercise is the best prescription for teaching muscles to work properly. A helpful strategy is to watch these muscles as they contract and relax so that proper exercise performance is achieved. The use of an ultrasound imager (similar to ones used to monitor the fetus during pregnancy) allows patients to see these deep abdominal and back muscles while they exercise.
Patients often come to physical therapy thinking they know how to use their muscles to support their spine. Viewing what is happening with the ultrasound imager is often an eye-opening experience. . . people often come back and ask to be rechecked with the imager to see if they are doing their exercises right. By that time, they usually are.
For back pain, see your PT ﬁrst
In most instances, lower back pain can be successfully treated with physical therapy, without the need for costly invasive procedures. In NorthCarolina, people have direct access to physical therapists, meaning that this beneﬁcial treatment does not require a physician’s referral. That gives one more reason to seek the professional treatment that you might need.
Paul Weiss, PT, Dip. MDT, is a physical therapist in practice since 1990. He is northwest Guilford County’s only Diplomate of the McKenzie Institute, a leading center for postgraduate study in back, neck and extremity pain. He is also the area’s leading expert on the use of ultrasound imaging in the rehabilitation of low back pain.