Physical Therapists: A Good Option for Back Pain 

In case you missed it, there was quite a bit of press surrounding an article recently published by medical researchers from Beth Israel Deaconess Medical Center in Boston about back pain treatment in the U.S. It is one of many studies that have concluded, one way or another, that we are relying too heavily on expensive, invasive, and ultimately ineffective treatments for low back and neck pain. The researchers looked at medical survey data between the years 1999-2010. Some of the highlights of the study include:

• An increase in the use of advanced diagnostic imaging (MRI, CT)
• An increase in medical referrals to specialists (Orthopedic Surgeons, Neurosurgeons)
• A 50% increase in the prescription of narcotics – perhaps most alarming of all
• No change in referral patterns to physical therapists

More imaging and more specialists for back pain equates to more cost and more invasive medical treatment. All of this is happening despite the consistent recommendation from clinical guidelines that conservative care, such as physical therapy and over-the-counter medication, play a central role in early management of most spine conditions. Further, our back pain problem in the U.S. is getting worse by almost any measure, including prevalence of low back and neck pain, and the number of people disabled by back conditions. Increased costs + poor outcome = bad medicine. The authors conclude that patients are largely driving these trends because many want a ‘quick fix’. Thus, we end up over-treating back pain, which can lead to adverse health consequences that require yet more treatment. This is the medical/surgical cascade effect. Not everyone needs treatment for back pain. When treatment is necessary, simple treatment is most often the best option. Patient education, exercise interventions and manual therapies are often the best medicine. These are the core elements of physical therapy management. Physical therapists offer comprehensive care for back pain and patients can now access their services without medical referral. 

Reference

Mafi JN et al. Worsening trends in the management and treatment of back pain. JAMA Intern Med. doi:10.1001/jamainternmed.2013.899

Marica Miller Spoto, PT, DC, OCS