Management Patterns in Acute Low Back Pain: The Role of Physical Therapy

Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine (Phila Pa 1976). 2012;37(9):775-782.

To read full text article click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062937/

Article Review by Kelly Beaudoin, MSPT

Low Back Pain

Business Woman suffering from acute back pain.

Every day in the clinic we treat patients suffering from acute low back pain and more than 90% of them improve rapidly, alleviating pain and improving function.  Acute low back pain intervention includes a combination of patient education, postural correction, physical therapy modalities, McKenzie method, manual therapy intervention, and appropriate therapeutic exercises. This article review supports the benefits of early physical therapy intervention in the treatment of acute low back pain.

GOAL, METHOD & FINDINGS

The goal of this research was to evaluate the relationship between early physical therapy (PT) use for acute low back pain and the use of other treatments for low back pain.

The method utilized was an analysis of a national 20% sample of the Centers for Medicare & Medicaid Services physician outpatient billing claims. Patients were selected who received treatment for low back pain between 2003 and 2004, excluding chronic low back conditions. Over 400,000 subjects were enrolled in this review making this a large cohort with significant finding.

Main outcome measures included rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain over the following year.

Findings: Early physical therapy was strongly associated with decreased use of lumbosacral injections, physician office visits for low back pain, and lumbar surgery, when compared with PT that occurred at later times.

 

SUPPORT FROM SIMILAR STUDIES

Low Back Pain Treatment

Physical therapist treating athlete with acute low back pain.

This finding is consistent with another recent study of active PT intervention for acute low back pain that reported an association between active PT within 90 days of onset of acute low back pain and decreased use of multiple healthcare resources in

cluding prescription medication, MRI imaging, and epidural injections in the year following discharge from PT. 4

Other studies have also demonstrated that physical therapy initiated within the first six weeks of low back pain leads to a wide range of improvements in disability, general health, social function, anxiety, depression, and mental health, when compared to only receiving advice to stay active.3

 

NEED FOR PHYSICAL THERAPY REFERRALS

On review of this study, it very interesting that although generalist medical specialties (Internal Medicine, Family Practice, and General Practice primary care physicians) had the highest proportion of office visits for acute back pain, they were associated with the lowest rates of subsequent PT referrals.

An additional study I found to support this conclusion indicated that generalist medical specialties primarily watch and wait to see how a patient’s symptoms progress versus referring to PT. 7

Given the potential benefits of early PT intervention, efforts should be directed at increasing appropriate PT referrals among general medical specialties. This may be highly beneficial in decreasing overall medical service used for low back pain complaints.

 

ARTICLE SUMMARY

  • Patients who received physical therapy within 30 days after initial physician visit for low back pain, have a decreased likelihood of receiving subsequent surgery or epidural steroid injections in the following year compared with those who received PT after 90 days.
  • The need for frequent office visits was significantly lower among patients who received PT within 30 days relative to those who received PT later.
  • Wide variation exists between medical specialties regarding PT referrals, with patients seen by generalist medical specialties receiving PT least often.

 

If you are searching for relief of acute low back pain, then skilled Physical Therapy intervention is a highly effective non-surgical treatment option to improve or resolve your condition. Skilled PT intervention can lead to decreased opioid and medication prescription, decreased imaging, and decreased need for subsequent medical intervention.

If you are tired of experiencing pain, it’s time to act! Call to schedule an appointment with a physical therapist today. Your therapist will develop a personalized treatment plan based on your evaluation findings to target your specific needs. Balance Solutions Physical Therapy is here to help, offering advanced physical therapy and manual therapy intervention for low back pain relief.

Balance Solutions Physical Therapy is located at Commerce Park in Beachwood Ohio, just on the outskirts of Cleveland. Services offered include physical therapy, massage, myofascial release, Integrative Dry Needling, as well as Pilates mat and reformer private and class lessons.

 

References

  1. Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine (Phila Pa 1976). 2012;37(9):775-782. doi:10.1097/BRS.0b013e3181d79a09
  2. Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. 2003 Jul 1;28:1363–1371. [PubMed] [Google Scholar]
  3. Wand BM, Bird C, McAuley JH, Dore CJ, MacDowell M, De Souza LH. Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise. Spine. 2004 Nov 1;29:2350–2356. [PubMed] [Google Scholar]
  4. Fritz JM, Cleland JA, Speckman M, Brennan GP, Hunter SJ. Physical therapy for acute low back pain: associations with subsequent healthcare costs. Spine. 2008 Jul 15;33:1800–1805. [PubMed] [Google Scholar]
  5. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018;53(6):4629-4646. doi:10.1111/1475-6773.12984
  6. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018;53(6):4629-4646. doi:10.1111/1475-6773.12984
  7. Spijker-Huiges A, Groenhof F, Winters JC, van Wijhe M, Groenier KH, van der Meer K. Radiating low back pain in general practice: incidence, prevalence, diagnosis, and long-term clinical course of illness. Scand J Prim Health Care. 2015;33(1):27-32. doi:10.3109/02813432.2015.1006462