Why should I see a Physical Therapist first for low back pain?
Low back pain is very common, and is the leading cause of activity limitation and work absence throughout much of the world. Individuals who have experienced activity-limiting low back pain often experience reoccurring episodes, and the prevalence of chronic low back pain has also significantly increased. Current research does not support a definitive cause for initial episodes of low back pain, and risk factors associated with low back pain are multifactorial, population specific, and only weakly associated with the development of low back pain (therefore, it is hard to "prevent" low back pain, as there are many factors that play a role!).
Patients often feel they need to go to their primary care physician at the onset of low back pain and have imaging or get a recommendation directly from the physician. Although it is not wrong to see your doctor, it can be better both financially and to decrease the risk of developing chronic low back pain to see a physical therapist first.
First, the American College of Physicians recommends that imaging (an xray or MRI) is only indicated in patients with low back pain if they are experiencing severe progressive neurological deficits (weakness of the legs, loss of bowel or bladder control) or when "red flags" are suspected (symptoms that may indicate a systemic cause of the pain, meaning it is not coming from the joints or muscles but from another system in the body). They also state that routine imaging in patients with low back pain does not result in clinical benefit and may lead to harm. Imaging is very expensive, and is simply not necessary in most cases of acute low back pain.
There are also numerous studies that have shown that early physical therapy intervention in acute low back pain significantly decreases the likelihood of progressing to chronic back pain. Another study found that those who were referred to physical therapy right away (within 4 weeks of onset) were less likely to receive injections or require frequent physician visits as compared to those referred after 3 months.
As Physical Therapists, we are trained to screen our patients for any concerns that may lead us to believe they should have imaging or see a physician. Many times a physical therapist can get you in and have you evaluated before you can even get in to see your primary care physician. In addition, research also indicates that individuals with low back pain should continue to move and maintain an active lifestyle, rather than rest or avoid activity while experiencing back pain.
The take away here: if you experience an acute onset of low back pain (or an exacerbation of previous low back pain), try seeing a PT first!! We can save you time and money, and help you learn ways to stay active and healthy throughout your life!
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Delitto, A., George, S., Van Dillen, L., Whitman, J., Sowa, G., Shekelle, P., Denninger, T., Godges, J. (2012). Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1-A57.
Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS