Who Should You See for Low Back Pain?



Having Low Back Pain is one of the common reasons for visiting a Primary Care Provider in the United States.

Initial treatment for LBP at this stage could range from prescription medications, use of imaging and diagnostic studies, instructions to rest and cease most activity and possibly a referral to physical therapy or other specialist. Early access to Physical Therapy services has shown to be helpful in preventing chronicity and repeated episodes of LBP but it's sometimes the last place the patient ends up. 

As a Physical Therapist I have new patients come to me every week with LBP and limitation doing normal activities and even their job, be it physically demanding or not. It isn't uncommon that I see patients with LBP of several months sometimes even a year's duration that have been on medications, have had an MRI (and have no idea what it revealed), have stopped all previous meaningful activity and are not better but only worse. Let's think about this, the patient and other payers have spent thousands of dollars looking for a solution and the patient at this point just wants an answer. Sadly, I don't think the scenario above is exclusive to me, many fellow professionals share the same frustration.

Sources and Causes of Low Back Pain

There is no certain cause of LBP. Many structures in the lumbar spine can be sources of pain when stressors are applied. Any structure that has a nerve supply has the potential to cause pain and in the lumbar spine these include but are not limited to, bones (vertebrae), joints, ligaments, nerves, intervertebral disc and muscles. All these structures are delicately interconnected and function as a system. During the initial Physical Therapy visit the functional movements that are limited and painful should be identified and emphasis on movement restoration, not just pain resolution be established as a primary focus.

There are a few activities I routinely hear about that aggravate a patient's pain; bending, sitting, standing, and walking. Sitting and standing by nature are static activities and I find can be made “less bad” with some practical instruction on posture, positional preference, ergonomic education and use of a lumbar support. Walking and bending are more complex to assess and this is where the Physical Therapy Examination and Evaluation will provide a proper explanation once carried out. See “What a PT Evaluation Should Be.”

Physical Therapy Intervention

A multitude of treatments exist for low back pain. Recent guidelines support identifying which patients will benefit from a specific treatment based on predictors found during the examination process. Manual Therapy, general exercise, traction, specific exercise, graded activity and patient education are just a few of the treatment approaches used in Physical Therapy, and they are often used in conjunction with each other, rarely as a stand alone treatment to optimize results. During the rehabilitation process patients should be reassessed and careful tracking of specific outcomes and measures should be consistent. It is important that worrisome signs and symptoms be continually tested and evaluated to determine if improvement has occurred or if there are signs of worsening that might justify an immediate referral to another specialist.

In summary, there is a need for the public to better understand the complexity of low back pain and how it can be managed. Causes of low back pain are difficult to pinpoint but a thorough examination by a Physical Therapist can be a great choice. Physical Therapy can be accessed directly in many states in the U.S. This means you don't necessarily have to go to your primary care physician to be referred to Physical Therapy. Often it is very appropriate to seek primary medical attention for specific conditions, however, Physical Therapists are among the professionals in medicine who are trained to identify conditions that require immediate referral to more appropriate services, this should ease your worry.

Contributed by Dr. Thomas Perreault

7 comments:

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  2. Jeromine CantonerosAugust 25, 2012 at 2:15 AM

    This is eye opening. Thanks

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  5. Thanks for sharing this. Great articles. I'm an OT and was introduced to the movement-based approach to treatment by Rick Daigle. Like you, we practice outside the box thinking in our clinical process as well, and just in the 2-3 weeks we have applied the movement-based it has shown us great results. Thanks for all you do.

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  6. Great! Movement based evaluation is one of the only reliable things we can assess. It's intrinsically meaningful for the patient as well as opposed to filling out questionnaires or useless special testing.

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  7. This comment has been removed by a blog administrator.

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