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1st Jun

2012

Early Physical Therapy for Acute Low Back Pain

Although up to 80% of people will at some point experience acute low back pain, and in most cases it will resolve on its own within 4-6 weeks (although with a high recurrence rate), recent large studies have shown that early start of physical therapy treatment may lead to less need for additional healthcare treatment down the road.

A new study led by Julie M. Fritz, PT, PhD, ATC, published in Spine, used a national data base of employer-sponsored health plans, where 32,070 patients had newly consulted a primary care physician for low back pain. Those who were referred to a physical therapist within 14 days of consultation were compared to patients who had their physical therapy referral delayed until 15-90 days after initial consultation with a physician. There were approximately an equal number of patients in each group.

During an 18-month follow up, the researchers found that early physical therapy treatment was associated with reduced likelihood of subsequent surgery, injections, physician visits, opioid use, advanced imaging, along with corresponding reduction in overall low back pain related medical costs, relative to delayed treatment by a physical therapist. The total healthcare cost was $2,736 lower in the early treatment group.

Another recently published study, taken from data from the Centers for Medicare and Medicaid Services looked at 439,195 patients who received treatment for acute low back pain, and who received physical therapy in the acute phase (< 4 weeks) versus in the chronic phase (> 3 months). The authors tried to the best of their ability to minimize differences between the patient groups. This study also showed less subsequent medical service usage among patients who received physical therapy early after an episode of acute low back pain, versus later on.

Dr. Fritz suggested that early physical therapy may promote a greater sense of self-reliance in managing low back pain and confidence in a positive outcome, and prevent a sense of dependency in the patients on additional health care services and medications.

Although the literature has shown evidence of moderate benefit of exercise therapy primarily for chronic and sub acute low back pain, a systematic review has shown strong evidence that exercise can reduce the future occurrence of back problems in adults. Another systematic review has given supervised exercise a distinct advantage over non exercise therapies or recommendations to simply exercise on your own, for chronic and recurrent low back pain.

The overall physical therapy utilization in the Fritz study was 7.0%. Another large North Carolina study some years back showed that only 3% of patients seen in physicians’ offices received structured physical therapy. The lead author of that study, Timothy S. Carey, M.D., expressed a concern about the overuse of narcotics and other medications, and the under use of physical therapy including exercise and other proven treatments.

Such under utilization of physical therapy may even extend to our youth. A Danish study, which examined 10,000 twins during an eight year period from adolescence to adulthood, showed that low back pain at an early age is a strong predictor of persistent low back pain later in life. The authors recommended early treatment for these young people.

It may be helpful to keep this information in mind when you, your family and friends see your physicians.

Best Wishes,

Gunnar

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