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1st May

2009

Physical Therapy Underused for Low Back Pain

Recurrent or chronic low back pain is a very common, and often disabling malady. Low back pain has also been found to be quite prevalent in adolescence and young adulthood. In this letter, I will discuss some recent research findings regarding treatment used for chronic low back pain, including physical therapy.

MANY TREATMENTS WITHOUT PROOF OF EFFECTIVENESS USED

Many treatments for chronic low back pain have shown little or no evidence of effectiveness, including narcotics and other medications, corsets/braces, education in lifting techniques, traction, and electrical stimulation and other thermoelectric modalities. Despite that, a recent large study out of North Carolina showed that many of these treatments are being frequently used for low back pain. As much as 61% of patients took narcotics over the past year, according to that study.

PHYSICAL THERAPY AND EXERCISE FOUND EFFECTIVE, BUT UNDERUSED

Although physical therapy and exercise therapy currently is being described in the literature as one of the few treatments for low back pain with moderately strong evidence of effectiveness, the North Carolina study showed that only 3% of patients had undergone structured physical therapy rehabilitation. Only 30% had seen a physical therapist at all, and less than 50% were prescribed some form of exercise. The lead author of that study, Timothy S. Carey, M.D., expressed a concern about the overuse of narcotics and other medications, and the underuse of physical therapy-exercise, and other proven treatments.

A 2009 review article in the Journal of the American Academy of Orthopaedic Surgeons also recommended physical therapy, saying that in most cases of painful low back disc degeneration, the most effective treatment is physical therapy combined with anti-inflammatory medication.

James Irrgang, PT, PhD, ATC, president of the Orthopeaedic Section of the American Physical Therapy Association, recently wrote that “for pain of mechanical origin such as low back pain, hands-on physical therapy (manual therapy) to mobilize the spine and exercise designed to alleviate low back pain have been shown to be particularly effective and have long-lasting effects on patients”.

Furthermore, the Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders recently presented research evidence statements, in which they supported the use of exercise as a treatment for neck pain. However, another recent study showed that patients with neck pain also were prescribed exercise in less than 50% of the time.

EARLY TREATMENT FOR LOW BACK PAIN IN ADOLESCENCE RECOMMENDED

A large Danish study a few years ago, on 10,000 twins followed for eight years from adolescence to adulthood showed that low back pain, especially persistent low back pain at an early age is a strong predictor of persistent low back pain later in life, with a four times increase in risk. The authors of that study recommended early treatment for these young people, in order to prevent more severe and chronic low back pain in adulthood. Therefore, physical therapy rehabilitation may be of great importance for adolescents who develop low back pain.

Looking at the information in this letter, we can see that repeated and often severe bouts of low back pain and chronic low back pain is very common, and often disabling. This is true also for neck pain. Physical therapy, especially orthopedic manual therapy, and including exercise therapy, has been found to be effective in many cases of back and neck pain. Yet, it is vastly underused by people today, likely because of the public and physicians not being fully aware of the potential benefits of physical therapy. Instead, treatments which have not been proven effective or worse have been proven ineffective, are being used much more often. Since low back pain in adolescents has been found to greatly increase the risk of developing chronic low back pain as adults, physical therapy rehabilitation could be of particular importance for these young people.

We recommend that you discuss this information with your physician, should you or your family and friends develop back or neck pain. Or you can call us directly, and we can provide a free consultation.

I hope this information has been of interest to you.

Best wishes,

Gunnar

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