#GetPT1st For Back Pain

by Dr. Sterling L. Carter, DPT, MS, CSCS, May 8, 2019

#GetPT1st For Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication: Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging: Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.

  • ● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not
  • ● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge
  • ● Just getting an image increases the chances that you’ll have surgery by 34%

Surgery: The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible!

A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t.  The surgical group had:

  • A 1 in 4 chance of a repeat surgery
  • A 1 in 3 chance of a major complication
  • A 1 in 3 chance of never returning to work again

Physical Therapy:

  • Current clinical practice guidelines support manual therapy and exercise
  • Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids
  • A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%
  • Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!