by Dr. Michael Baranov, PT, June 23, 2015
Here’s an interesting anecdote that was shared by someone that does a lot of computer work & writing. He communicated his thoughts with me on finding a back pain specialist in Fresh Meadows when prevention, as outlined below, is not enough.
He’s talking about preventing low back pain (the acronym we use in PT is LBP & that’s what you see in the blog title here), but most of my patients call in lower back pain.
The Prevention Story (make sure you read beyond it though)
“Twenty years ago, I would laugh whenever I saw people in their 40’s and above grimace so uncomfortably during the simple act of bending over to pick up the morning newspaper. Now that I myself am enduring my 40’s, I am thankful that I can get all the news I need from a computer screen or smartphone instead. However, I still grimace at some other very simple tasks associated with every day life. As my older brother and I routinely say when we get together these days: ‘It stinks to get old.’ Truth is, it really doesn’t have to. Here are three of the most common causes of back pain and their fairly simple solutions:
Honey I Shrunk Myself While Looking at The Computer Screen – Whether at work, home, or on the train commuting most of us are spending around nine hours per day hunched over a computer screen of some sort. It’s actually causing a generation of cyber hunchbacks. The fact is that the posture of sitting down and leaning your upper back forward is one of the unhealthiest and potentially most harmful positions you can subject your spine to. Spare yourself from this malady by getting up and moving around every 20 minutes. Try getting a supportive chair and adjust it to fit your unique posture. When possible, keep reading material at eye level. These very simple and easily doable acts can save your back from a world of hurt.
The Weekend Warrior – What happens to most people who are athletes in their teens and twenties? Simple, they think they’re still athletes in their 40s and over. Yes, at middle age and beyond the weekend finally arrives and most former athletes still venture on to the golf course or the basketball court to get their athletic fix in. The problem is they don’t properly warm up or stretch first. Put your core muscles to work with a light exercise routine 4-5 times per week, and take the time to stretch before teeing it up on Sunday.
Poor Form – Perhaps the most common form of acute back injury comes from improper lifting technique. You should keep your back as straight as possible while bending with your knees. Keep the object close to you. Do not twist at the waist when turning. Instead, use your feet to turn.”
When Prevention Doesn’t Word…Which is Common
This is good advice but the fact still remains that a whooping 80% of the members in our community here will experience lower back pain at one time or another. Of course, there are many treatment options…so many that it cam be very confusing for the average consumer. I’d like to suggest that if you are looking for a back pain specialist in Fresh Meadows, our physical therapists should be the first ones you see. Here’s why. Consider this most recent research study published by John Childs, et. al. This is called an Abstract. It is a summary of the research paper.
Background: Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS).
Methods: Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models.
Results: 753,450 eligible patients with a primary care visit for LBP between 18–60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs.
Conclusions: The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients. Reference: Implications of early and guideline adherent physical therapy for low back pain on utilization and costs . You can get the entire paper for free, click here.
Take Home Messages
I’d like to point out some important points regarding this study and therefore, why you should see a physical therapist first.
1. This study concluded that “early” physical therapy is important. “Watchful waiting” or suffering while you wait for the pain to go away, isn’t the best treatment. Seeing a physical therapist first is.
2. Adherent Physical Therapy is best practice and involves patient education, hands-on care, and exercise (following evidence-based practice)…not ultrasound, massage, and heat. Heat and ice can be useful but you can do those things at home.
3. The size of the study. Physical therapy studies are often criticized for their poor sample sizes. This study looked at data from 753,450 patients. This is a high-power study.
4. Physical therapy wasn’t used nearly enough – only 16% ever saw a physical therapist.
5. Poor physical therapy was the norm – only 24% of the 16% that even saw a physical therapist had good care or… adherent physical therapy.
6. Early referral to physical therapy resulted in a whopping 60% cost savings…yes, 60%!
7. Those that saw a physical therapist first and fast had fewer tests, saw fewer physician specialist visits, had fewer low back injections (epidurals), and used fewer pain pills.
Note, there are some limitations and the authors point them out but the conclusion is clear – SEE ONE OF OUR PHYSICAL THERAPISTS FIRST AND FAST IF YOU LIVE HERE IN FRESH MEADOWS.