The role of physical therapy in the treatment of low back pain is becoming increasingly popular. Over time, data has shown that rest is not the best treatment for low back pain, with guidelines increasingly supporting the use of physical exercise for non-specific low back pain. Current recommendations list many types of physical activities including yoga, biofeedback, core strengthening exercises, progressive muscle relaxation, massage, manual therapy, and interdisciplinary rehabilitation. So how do you know which exercise to try, or when to try physical therapy? And what should you know before searching for a physical therapist near you to treat your low back pain?
Moving away from Medication
In the past opioids and surgery were often used as first line treatment for chronic low back pain. With the recognition of the growing opioid crisis it was a welcome change when guidelines began to shift away from first line pharmaceutical treatment. As part of the campaign against opioid use, the CDC has endorsed physical therapy as a nonpharmacological alternative (no drugs involved) to pain relief and the American College of Physicians (ACP) 2017 guidelines recommends starting with techniques commonly used by physical therapists, rather than using pain relief drugs to treat low back pain. We are seeing increasing support for this treatment option for low back pain.
When to see a Physical Therapist
Physical therapists are specialists who are licensed to treat a variety of musculo-skeletal ailments. They are able to address specific injuries as well as issues related to the normal “wear and tear” on our bodies. Physical therapy can be an effective way of treating the symptoms of low back pain, like decreased range of motion and strength. By teaching core strength exercises, and improving flexibility, physical therapy can help with the performance of daily activities, and it can help prevent future low back pain episodes.
The most common reason that people see a physical therapist is to address pain or an injury that is impacting their ability to go about their daily lives. Some people also turn to physical therapy after having had surgery so that they can restore their level of function and mobility. If, however, you have sharp, sudden pain that gets worse with movement, or if you have an inability to move a certain body part, then you might not be ready for physical therapy just yet.
What To Expect From a Physical Therapy Session
Under current US treatment guidelines, patients suffering from most types of low back pain are often given a referral for 4 weeks of physical therapy. Your first physical therapy visit generally consists of 3 parts: history, examination, and evaluation.
Your physical therapist will conduct a thorough examination and assessment and work with you to develop goals to help you improve function. A physical therapist is considered a movement specialist and is licensed by the state. To find out more information visit the APTA (American Physical Therapy Association).
Types of Treatments used by Physical Therapists
Physical therapy treatment can consist of any of the following treatments:
Movement based activities (stretching/range of motion activities)
Specific strengthening exercises
Pain relief exercises
Low impact aerobic conditioning
Progressive endurance/fitness exercises
Core strengthening exercises
What To Know Before Scheduling a PT Appointment
Benefits of PT
Research has shown that starting PT as soon as possible after experiencing acute low back pain, saves patients money, and reduces the need for medications and surgery. In a study of approximately 150,000 insurance health claims, published in the May 23, 2018, issue of Health Services Research, the majority of participants (about 80 percent) did not see a physical therapist. Just under 9 percent actually saw a physical therapist first, and the remaining 11 percent saw a physical therapist later (the average time elapsed was 38 days).
Those who visited a physical therapist first were 89 percent less likely to receive an opioid prescription; 28 percent less likely to need imaging tests like a computed tomography (CT) scan or magnetic resonance imaging (MRI); and 15 percent less likely to visit an emergency room. They also had significantly lower out-of-pocket, pharmacy, and outpatient (including imaging) healthcare costs, although they paid more in provider costs to see a physical therapist.
Things to Consider Before Scheduling a PT Appointment
1. How Much Time Do You Have?
When it comes to physical therapy, the two biggest challenges facing patients are cost and time. Not everyone lives in an area that has a physical therapist, or if there is a physical therapy clinic, your insurance may not be in network with that specific provider. This means that you may have to travel extensively to find a provider that is covered by your insurance.
Another concern with PT is the cost. This can vary dramatically depending on your specific insurance coverage. For those that are fortunate enough to have health insurance, co-pays can be as high as $75 per session, and your insurance company may limit the number of sessions that you can receive. Patients paying cash can pay up to $250 per session. Medicare Part B covers 80 percent of the approved cost, once you’ve met your deductible (which was $183 in 2018), but it puts yearly caps on outpatient rehabilitation services, which in 2018 was $2,010.
If you are considering PT it might be an idea to go directly to a physical therapist for your initial consultation. Many states have direct access, meaning that patients can visit a physical therapist without getting a referral from their doctor. Just check with your insurance company first, to make sure PT visits are included, and to find out how many sessions it will cover. If you do have any red flags, however, then a visit to your regular healthcare provider is always a good idea before starting any new program or treatment for low back pain.
For now, just know that physical therapy can help reduce many types of aches and pains and fix your imbalances, and it can also help you better understand your body and prevent future pain and injuries, helping you to stay active and enjoy the activities you love.
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