Healthy Back Tips

April 2009

Medical Intervention vs. Physical Therapy Involvement in the Management of Chronic Back Pain

FIn October 2008, a prominent spine specialist named Richard Deyo, M.D. was the keynote speaker at a National Physical Therapy Conference in Seattle, Washington. He spoke about a study published in the January 2009 issue of the American Board of Family Practice which demonstrated that the U.S. approach to chronic back pain dramatically increased costs without improving outcomes. He cited the following statistics during the past 12 years:

  1. 629% increase in Medicare expenditures for epidural steroid injections
  2. 423% increase expenditures for pain medication (opiods) for back pain
  3. 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries
  4. 220% increase in spine fusion surgery rates.

These staggering statistics are quite alarming given that the overall incidence of low back pain (as documented by the number of office visits) has not changed during this time period. The authors concluded, according to Deyo, that “ordering more imaging studies, prescribing more pain medications and performing more injections and spine operations is not likely to improve outcomes for patients with chronic low back pain.” These types of medical interventions are more helpful for patients in acute pain, but apparently chronic pain management requires a different model. As Deyo points out, there are no magic bullets when treating chronic back pain. The best approach at present involves a sustained commitment from a healthcare provider, recognition of patient self responsibility for their own health, education in self care, an emphasis on exercise and early return to work and social/recreational activities.

In comparison to medical interventions for chronic back pain, physical therapy utilizes a low risk, minimal cost, patient oriented educational approach. Patient satisfaction surveys regarding physical therapy care for back pain consistently demonstrate high scores when compared to other health practitioners. The physical therapist most qualified to evaluate and treat individuals with chronic low back pain are physical therapists that are trained in manual (hands on) therapy. 

The manual physical therapist is specifically educated and skilled to care for the spinal pain patient by being able to systematically evaluate the problem(s) and establish a logically reasoned treatment plan. Treatment involves the effective use of manual therapy skills as well as proper education in regards to posture, body mechanics and exercise. Most importantly, the manually trained physical therapist considers the whole person in determining the best management strategy for chronic pain and not just the results of an imaging study. In comparison to the potential risks and complications from imaging studies, medications, injections and surgery the risks in physical therapy are minimal with the potential rewards (benefits) being high.

Perhaps the time has come for physical therapy to be a point of entry into the health care system for individuals with chronic back pain. The evidence is becoming clear that applying high cost medical technology to the problem of chronic back pain is not necessarily the most effective intervention. Maybe the help you need for your chronic back pain resides in a physical therapist that specializes in spine conditions rather than in imaging studies, pain medications, spine injections or surgeries.

For more information specific to your condition, contact the Atlanta Back Clinic, or call us at 770-491-6004 to set up an appointment with a physical therapist.