Time to see a Physical Therapist, PT?
By Dr. Greg Synnestvedt PT DPT
Have you ever had physical therapy? Some people picture typical physical therapy as the rehabilitative process that a person goes through after joint replacement surgery. While this is one important time to participate in therapy, most people in a physical therapy clinic are coming for very common pains. The most common areas people seek PT for are 1) low back pain 2) shoulder pain and 3) knee pain. There are also people who are not in any pain at all (lucky them!) but want to improve their balance, walking, mobility, or ability to do daily tasks.
When is the right time to see a physical therapist? If you are trying other treatments for an ache or pain, it is worth seeing a physical therapist to get their opinion before going to other specialists. A recent study found that seeing a physical therapist first for low back pain reduced the overall healthcare costs and also reduced the chances of opioid prescription down the road. Whoever you see first in the healthcare system has a large impact on your path through the system—this is not the way it should be, but this is how it is. You can see a physical therapist with a direct access license for 30 days before requiring a referral from your physician, and this could give you enough time to see that you will be okay without an injection, procedure, or expensive MRI right off the bat. If your physical therapist thinks that your situation requires your physician’s attention, they will refer you to the physician for consultation.
A similar study to the one mentioned above found that early physical therapy for people with neck pain reduced the rate of imaging, opioid prescriptions, and overall costs. Early was defined as people who saw a physical therapist within 3 months. If you have an issue for more than a few weeks that isn’t getting better, it could be useful to consider trying PT.
As patients, we usually seek the “silver bullet” treatment, though this rarely exists. Ture healing and improving are nearly always processes involving time and effort. Take, for example, knee pain from arthritis, which is a very common problem. The clinical practice guidelines put out by the Academy of Orthopedic Surgeons recommends physical therapy as a primary treatment for knee arthritis, with strong evidence. Despite this recommendation, non-recommended treatments such as hyaluronic acid injections, corticosteroid injections, and opioids remain among the most commonly utilized treatments for patients in the year leading up to joint replacement (Bedard et al., 2017). This study estimated a 45% healthcare savings if only the recommended treatments were used. This is not to say that injection is never useful, but that it is worth trying physical therapy.
As a patient, you are your best advocate. If you have a joint or muscle pain or difficulty moving, ask your doctor for a referral to physical therapy and see what PT can do for you.
Bedard, Nicholas A., et al. “The AAHKS Clinical Research Award: what are the costs of knee osteoarthritis in the year prior to total knee arthroplasty?.” The Journal of arthroplasty32.9 (2017): S8-S10.
1: Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018 Dec;53(6):4629-4646. DOI: 10.1111/1475-6773.12984.
Epub 2018 May 23. PubMed PMID: 29790166; PubMed Central PMCID: PMC6232429.
Horn, Maggie E., and Julie M. Fritz. “Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort.” BMC health services research 18.1 (2018): 887.
Study: Seeing a PT First for LBP Lowers Overall Costs, Reduces Chances of Later Opioid Prescription
https://www.apta.org/PTinMotion/News/2018/05/24/PTFirstForLBP/
Study: Early Physical Therapy for Neck Pain Associated With Lower Imaging Rates, Opioid Prescriptions, and Overall Cost
https://www.apta.org/PTinMotion/News/2018/12/04/EarlyPTNeckPain/
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