Think about it, between our family and friends, we all know someone who is currently dealing with low back pain, (LBP), or has suffered from it in the past. It is one of the most common reasons for physician visits in the U.S. and the American Physical Therapy Association, (APTA) states that 90% of Americans will experience back pain at one point in their lives. The APTA states that, at any given time, 25% of the U.S. population will report having experienced back pain in the last 3 months. Within this population of individuals suffering from low back pain, 60% have a prescription for opioids.
In May of 2018, the Journal of Health Services Research published a study that caught national attention and was highlighted on major news outlets. The study looked at over 150,000 claims filed with health insurance companies from the time of an individual’s initial visit with a provider regarding their low back pain through the course of 1 year of treatment. They found that, by using physical therapy as the first line of treatment for low back pain, patients were able to reduce costs and reliance on addictive opioids.
The study differentiated individuals who received physical therapy early on versus those who saw a family doctor or specialist and subsequently started therapy at a later date, if at all. It found that patients who saw a physical therapist first had an 89% lower probability of starting opioids. They also had a 15% lower probability of visiting the ER and a 28% lower probability of having advanced imaging. Overall, patients who saw a PT first had significantly lower out-of-pocket expenses and saved on average around $500.
Literature promotes early resumption of normal activities, patient education on self-management of symptoms, and low-back exercise, while it discourages bed rest. In fact, passive methods such as rest are associated with worsened disability.
One of the best ways to learn more about self-management and to begin an exercise program is to work with a physical therapist. The APTA refers to PTs as movement experts who can prescribe a low-back exercise program to meet an individual’s goals
and needs.
When an individual comes to physical therapy for low-back pain, LBP, he or she is evaluated based on personal symptoms.
It is important for the provider to listen to his or her goals and limitations.
Together a plan can be tailored to suit the patient’s needs. It might incorporate stretching and strengthening to help manage pain. Patients will also receive education on how to prevent recurrent pain episodes and reduce their risk for reinjury. With the tools learned in therapy, patients will gain a better understanding of the activities that may provoke their symptoms and how to manage them when they occur.
No one exercise program works for every person. That is why a thorough evaluation is done to learn about a patient’s movement patterns. The therapist should be able to identify any postural asymmetry that can be corrected through the exercise program. They will also train the patient in proper body mechanics for tasks such as lifting, bed mobility, and household duties.
Many individuals are unaware of the movement patterns they develop to compensate for their pain. They may exhibit a pattern of walking that minimizes stance time on one leg or shift their center of mass away from their side of pain. Our job as physical therapists is to get to the root cause of these or other movement problems.
For example, one individual may exhibit a very forward flexed posture and have difficulty standing or walking for prolonged periods of time. This may be due to weakness in his or her hip extensors and tightness in the hip flexors. This person may be given exercises to work on strengthening the gluteal muscles and core, stretches for the psoas muscles, and a conditioning program to improve stamina for walking.
Another individual may suddenly develop acute pain when he or she has to sit or stand straight and have associated leg pain, such as that experienced with sciatica. This individual may be taken through a progression of McKenzie extension bias low-back exercises focusing on restoring normal spine mobility, while simultaneously receive exercises for sciatica to reduce the neural tension and pain in the leg.
We educate our patients on what activities are their personal triggers and how they can manage their participation in those activities with less pain. For example, if a patient tells me he or she loves to cook but has a lot of pain afterward, I teach him or her strategies to reduce the severity of the symptoms both during and after the task.
The point is that each person has a different presentation and a different set of goals. As physical therapists, our job is to help identify a path to achieving those goals and prevention exercises to avoid recurrence. Physical therapy can help stave off unnecessary invasive procedures or the use of habit-forming medications.
If you would like to learn more about managing and relieving your back pain, please consider physical therapy as your first choice of treatment. We can help build you a program that will give you the confidence and independence you need to conquer your low-back pain. Please contact us today to schedule your initial evaluation and get the ball rolling toward better pain control and improved function.
For reference information, visit Move Forward PT/Low Back Pain/
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