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 actually the best treatment for low back pain. This may be a surprise to you since so many doctors still recommend it, but guidelines increasingly support the use of physical exercise for non-specific low back pain, and they also recommend physical therapy.
What Do The Guidelines Recommend?
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 if physical therapy is the better option? 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 to treat 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.
When To See A Physical Therapist For Back Pain?
The most common reason that people see a physical therapist is to address pain or to fix 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 then conduct a thorough examination and assessment and work with you to develop goals to help you improve function.
Physical therapists are considered movement specialists, they generally study for around 7 years! This means that they are uniquely qualified to understand how your body works and how to use the latest tools and techniques to manage pain conditions.
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).
The results of the study found that 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.
The physical therapy recipients also had significantly lower out-of-pocket, pharmacy, and outpatient (including imaging) healthcare costs, although they did pay more in provider costs to see a physical therapist.
Things to Consider Before Scheduling a PT Appointment
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.
If you don't have insurance, or if you have a large deductible to meet, you might need to pay cash. 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.
How To Book An Appointment With A PT
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.
Something to keep in mind is that it is a good idea to check with your insurance company first, to make sure PT visits are included, and to find out how many sessions they will cover.
Also, if you have any red flags associated with your low back pain then a visit to your regular healthcare provider is always a good idea before starting any new program or treatment for low back pain.
The Role Of Digital Physical Therapy
For those who don't have access to insurance or struggle to find the time to get to physical therapy, a new option is growing in popularity: digital physical therapy.
Digital PT can refer to any type of physical therapy that is delivered via electronic means, but lately digital clinics that offer in-home physical therapy are what digital PT is often referring to.
Digital physical therapy clinics offer users the opportunity to complete physical therapy exercises from the comfort and convenience of their own home. This means that more people are able to access physical therapy since they don't need to arrange for childcare, take time off work, or spend time traveling to appointments.
If you don't have insurance, have a huge deductible, can't take time off work or time away from home then the digital version of physical therapy might be the option for you. To learn more about this type of therapy you can read more about it in our blog '6 Key Benefits Of Virtual Physical Therapy For Low Back Pain'.
For now, just know that physical therapy can help reduce many types of aches and pains and fix your imbalances. Physical therapy can also help you better understand your body, how your daily activities could be causing your low back pain, and help you prevent future pain and injuries.
With evidence to show the effectiveness of this type of therapy for low back pain, and the guideline recommendations to back it up, physical therapy can be a great option for managing and preventing lower back pain, helping you to stay active and enjoy the activities you love.
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