Physical therapy for lower back pain is not a new way to approach chronic pain, but many people may not believe that it is worth the time and effort it takes. Research is proving that a qualified physical therapist offering consistent physical therapy for lower back pain can make a difference in the outcome and overall cost of pain treatment.
Physical therapy for lower back pain improves outcomes
Most people utilize physical therapy after a surgical intervention for chronic pain (e.g., disc decompression). Research from the American Academy of Orthopaedic Surgeons found that those undergoing total hip (THR) or total knee replacement (TKR) surgery who had physical therapy before their surgery reduced their post-operative care needs by 30%, saving over $1,200 in the process.
Orthopaedic surgeon Ray Wasielewski, MD, co-author of the study, cited the cost-effectiveness and better outcomes of pre-operative physical therapy as an important finding, noting:
“This study demonstrated an important opportunity to pre-empt postoperative outcome variances by implementing preoperative physical therapy along with management of comorbidities before and during surgery.”
Another study from the American Physical Therapy Association found that physical therapy over a two-year period after an episode of acute, non-specific lower back pain greatly reduced costs associated with treatment and also improved outcomes.
Researchers looks at nearly 123,000 back pain patients to see which treatment plans offered the best results in terms of pain reduction and use of medical resources (e.g., imaging). All patients visited a primary care physician and began physical therapy for lower back pain within 90 days. Of these, the 24% who received early physical therapy (within two weeks) and stuck to the guidelines had much improved outcomes.
- They had less advanced imaging, lumbar spinal injections, lumbar spine surgery, and opioid use
- Costs for early physical therapy reduced overall treatment costs by approximately 60% (as compared to 33.5% for those who had physical therapy between 14 and 90 days)
Physical therapist researcher John D. Childs, PT, PhD believes that using physical therapy sooner rather than later is key in improving outcomes, noting:
“Physical therapy as the starting point of care in your low back pain episode can have significant positive implications. Receiving physical therapy treatment that adheres to practice guidelines even furthers than benefit.”
Cost effectiveness of physical therapy
For example, for knee osteoarthritis, regular physical therapy over a 12-month period is more cost effective and produces better outcomes for patients.
The American College of Rheumatology (ACR) presented research at the American College of Rheumatology annual meeting that looked at four different ways of presenting physical therapy:
- Strategy one: Twelve sessions of physical therapy alone over nine weeks
- Strategy two: Eight initial sessions of physical therapy over nine weeks plus four “booster” sessions at three time points (two boosters at month five and one at months eight and 11) over twelve months
- Strategy three: Twelve sessions of physical therapy plus manual therapy over 12 months
- Strategy four: Eight initial sessions of exercise therapy plus manual therapy and four booster sessions over 12 months
Care costs were reported by patients and cross-referenced using Medicare physician fees and data from the Healthcare Utilization Project. Results of the study show that those patients who received booster sessions and manual therapy experienced better quality of life outcomes and reduced costs nearing $1,100.
Lead investigator in the study, Allyn Bove, PT, DPT, assistant professor in the department of physical therapy and the University of Pittsburgh School of Health and Rehabilitation Sciences, pointed out that these recommendations offer guidelines for both the amount and frequency of physical therapy, noting:
“These results indicate that supplementing exercise with manual therapy and spacing physical therapy sessions across a longer period of time may provide greater benefit to individuals with knee osteoarthritis, while simultaneously reducing downstream health care utilization.”
How to find a physical therapist
Beginning physical therapy for lower back pain before a procedure or as soon as possible after acute pain can be key to recovery from all kinds of pain conditions. The key is finding a good physical therapist.
Check with your doctor
Your doctor may have a physical therapy practice they work with, or they may have several recommendations.
Ask family and friends
Family and friends may be the best source for recommendations. Knowing a name and reading reviews is one thing, but actually working with a person is another. Family and friends can tell you about a therapist’s style and “bedside manner.”
Use online search tools
The American Physical Therapy Association (APTA) has an online search tool that can make finding a physical therapist near you much easier. Their therapists are registered and listed by specialty.
Preparing for physical therapy for lower back pain
In your first meeting with your physical therapist, it is important to bring your medical records with you (including MRIs, doctors notes, diagnoses, and current prescriptions). The physical therapist will ask questions about your current condition as well as other questions about your lifestyle and current activity levels.
Each physical therapy session may be different depending on how you are feeling that day (and they will vary based on what condition is being addressed). The physical therapist will guide you through a series of exercises designed to strengthen and support the body.
Make no mistake: physical therapy sessions may not be comfortable, but think of the sensations as “therapeutic irritation” rather than pain. You may be accessing muscles and parts of the body that have been stressed, strained, or ignored. This is part of the healing process and can be challenging.
Openly communicating with your physical therapist can help them better understand how you are feeling both mentally and physically. This is important in the process, as your mental health can influence your physical progress. Your physical therapist can help you to stay focused and encouraged as you work towards strength and rehabilitation.
Another important part of physical therapy is exercises designed for you to complete at home between physical therapy sessions. These help you to stay consistent in your rehabilitation and can help improve outcomes.
Have you used physical therapy to recover from an acute pain condition or a surgical intervention? What did you think?