Posts in back and leg pain
Cost Effectiveness of Physical Therapy for Low Back Pain

Low back pain continues to affect many Americans leading to pain, loss of function, missed work days, and higher health care expenditures.  Much of this cost is attributed to the often unnecessary utilization of advanced imaging and procedures such as injections and surgery.  Previous research has shown early access to Physical Therapy without a prior MD referral saves patients on average $1000 per episode of care.  Further cost savings are noted if patients are treated early with Physical Therapy compared to national guidelines advocating a "wait and see" approach for care prior to deciding on Physical Therapy.  

A recent study was conducted to determine the cost effectiveness of primary care management with or without the use of early Physical Therapy for patients with acute low back pain (Fritz et al. Physical Therapy. 2016).  Economic data was collected on 220 patients with acute low back pain who were all treated with primary care management (education, medication) and then randomized to either 4 sessions of early Physical Therapy or primary care management alone.  The authors collected costs (health care treatments, loss time at work) associated with this episode of back pain.  The authors concluded that Physical Therapy was associated with higher quality of life scores at 1 year and was sufficiently cost effective to support its' early use for patients with acute low back pain.

Patients with low back pain are encouraged to seek out the services of a local Physical Therapist to reduce health care costs and improve symptoms and function compared to primary care management alone.  

Resolution of Lumbar Disk Herniation Without Surgery

Physical Therapy remains the first line treatment for lumbar disk injuries due to its' non invasive nature and clinical effectiveness.  The natural history of disk injuries is not well established but preliminary data covered in prior blog posts demonstrates regression of these injuries over time.  A recent case study in the New England Journal of Medicine (Hong et al. 2016) described the case of a 29 year old female with pain and pins and needles into her leg.  Her MRI is shown above on the left side of the screen.  The patient did not want surgery and was instead treated with an injection and Physical Therapy.  After 5 months a second MRI was taken, shown on the right, showing resolution of the disk injury. 

This case adds evidence to the regression and resolution of disk injuries over time with conservative care.  Patients are advised to seek care from a local Physical Therapist before attempting more invasive and costly procedures.

Does One Size Fit All in Physical Therapy?
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In our fast paced, instant gratification world we want solutions to our problems the same day as their arrival.  This is no different in low back pain, a common, costly condition affecting over 90% of adults.  Patient's hurting from low back pain symptoms often turn to the internet, friends, or their primary care physician for quick solutions to their problem.  Although low back pain is common, the reasons behind the pain are multifactorial in nature limiting the effectiveness of a one size fits all approach.  Thus, patients seeking advice online, from friends, or their physician may be given an inappropriate or ineffective treatment plan leading to lost time, lost employment and money.  In the past, clinical guidelines on low back pain have been created by medical and government agencies in an attempt to help guide decision making for all patients with low back pain.  Not surprisingly, research has shown the limitation of this one size fits all approach with lower costs and improved outcomes observed with Physical Therapy compared to guidelines.  

A more recent article in British Journal of Sports Medicine was published to compare the outcomes between general advice and patient specific Physical Therapy treatments (Ford et al. 2016).  200 patients with low back pain, less than 6 months in nature, were randomized to either an education group or to 10 sessions of Physical Therapy interventions including manual therapy and exercise.  Consistent with prior research a patient specific plan of care showed better outcomes at 10, 26, and 52 weeks compared with an education only approach.  

This article adds to the existing literature indicating the importance of early, patient specific Physical Therapy treatment compared to advice or a wait and see approach.  To learn more on how Physical Therapy can help get accelerate your recovery from low back pain contact a local Physical Therapist. 

Dry Needling for Low Back Pain

Dry needling treatments performed by Physical Therapists have gained in popularity among both clinicians and patients.  The treatment is designed to reduce pain and restore muscle function.   Inserting small, monofilament needs into trigger points within painful muscle groups can lead to immediate changes in pain and movement.  While the mechanism of these treatments is still being investigated early research indicates beneficial changes in circulation, nervous system, and muscle function are noted after Dry Needling.  Consistent with many other treatments for a patient's pain there is likely a group of patients with pain who will benefit most from this Physical Therapy intervention.    

Prior research has identified baseline examination items which help predict success with this treatment (Koppenhaver et al. JOSPT. 2015).  72 patients with low back pain underwent an examination followed by a single treatment of dry needling by a Physical Therapist.  These patients were re assessed one week after treatment.  Patients who experienced pain during the exam on a muscle activation test had the best response to the dry needling.  These findings make sense given the treatment's attempt to decrease muscular or myofascial pain often provoked by muscle contraction or stretch.  

This same author recently completed a second study to determine which clinical changes are associated with reductions in pain and disability following Physical Therapy dry needling (Koppenhaver et al. Man Ther. 2016).  66 patients with low back pain underwent one session of dry needling to the lumbar muscles following a Physical Therapy examination and ultrasound assessment of their low back muscles.  Pain threshold was assessed based on the patient's ability to tolerate pressure across the lumbar spine.  The authors found the individuals with the greatest improvement in symptoms and function after needling also had the greatest improvements in pain tolerance and muscle function at 1 week post needling.  

This evidence adds to our knowledge on the effects of dry needling in patients with low back pain.  Those who respond best to this treatment may be individuals who have the greatest improvements in pain and lumbar muscle function.  To learn more on how dry needling can decrease your pain and improve your function contact your local Physical Therapist. 

Prevention of Low Back Pain
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The 3 inevitable events in our society include death, taxes, and low back pain.  Many of us will experience a significant episode of low back pain in our lives but the vast majority of these symptoms are not associated with serious pathology such as fracture or cancer.  In our previous posts on low back pain we have detailed the risk of false positive findings on imaging (MRI and CT scans) and the cost of early, unnecessary imaging which contributes to the > 100 million we spend on low back pain each year.  This cost is greater than what we spend on cancer or foreign aid each year.  The high incidence of symptoms and money associated with low back pain has driven all types of passive treatments (electrical stimulation, creams, back braces, postural supports) and gizmos designed to reduce the symptoms of low back pain.  Thankfully, there is an inexpensive, powerful tool which has the greatest ability to reduce the incidence of low back pain in our country.   

Previous research has shown staying active with a strengthening program after an episode of low back pain can significantly reduce a client's risk of recurrence.  Exercise has consistently been shown to be the most effective treatment available to reduce a patient's first time or future risk of low back pain.  A recent review article in the Journal of the American Medical Association confirms these findings (Steffens et al. 2016).  Authors reviewed 21 randomized controlled trials of various interventions for low back pain including a total of 30,000 patients.  They found overwhelming support for exercise, regardless of type, to reduce a patient's risk of low back pain.  Patient's who exercised had roughly half the risk of symptoms compared to their sedentary peers.  

To learn more on how exercise can reduce your risk of low back pain contact your local Physical Therapist.  

Exercise as Medicine

At Mend, we provide every patient with an individualized exercise program specific to their condition.   These programs are focused to deliver optimal results in the least amount of time possible.  Exercise is one of our most powerful interventions to eliminate pain and restore function without the use of more risky medications or surgery.  The American College of Sports Medicine has launched an Exercise is Medicine campaign to heighten the awareness of this powerful tool.  In addition, evidence continues to mount on the beneficial effects of exercise on our physical, mental, and emotional health, as well as, its' impact on many chronic illnesses. 

A recent literature review in the Scandanavian Journal of Medicine and Sports in Exercise highlighted the evidence behind the use of exercise on 26 chronic health conditions from Depression to Dementia (Pedersen et al. 2015).  The authors explained the exercise parameters most effective to combat each disease, as well as, the evidence on how exercise may impact the development and progression of each disease.  A list of the 26 conditions can be found below.  To learn more about how you can utilize exercise to help treat your condition contact your local Physical Therapist.

Psychiatric Diseases
Neurological Diseases
     Parkinson's Disease
     Multiple Sclerosis
Metabolic Diseases
     Metabolic Syndrome
     Polycystic Ovarian Syndrome
     Type I and II Diabetes
Cardiovascular Diseases
     Cerebral Apoplexy
     Coronary Heart Disease
     Heart Failure
     Intermittent Claudication
Pulmonary Diseases
     Cystic Fibrosis
Musculoskeletal Disorders
     Back Pain
     Rheumatoid Arthritis