You’ve had lower back pain for two weeks, so finally you decide that enough is enough and make an appointment with your doctor. Your doctor’s decision about what to do next can have a big impact on how quickly your back pain resolves. Research has shown that some courses of action work better than others.
Believe it or not, some decisions lead to higher costs and poorer outcomes:
Delayed Treatment: The subjects were 32,070 patients with a low back pain diagnosis from their primary care physicians. Those who received therapy within 14 days of their initial doctor visit had fewer follow up visits, a lower incidence of advanced imaging, fewer injections, fewer surgeries, and decreased use of opioid medications compared with those who delayed the initiation of physical therapy. ¹
MRI: With patients who saw their primary care doctor for a new low back pain problem, those who went directly to PT spent, on average, $1871. People who had an MRI first spent an average of $6,664 in the year following their initial complaint to their doctors. Don’t get me wrong – there is a place for MRI and CT scans, but it’s not the first thing to go to for low back pain. ²
Why? Why would just having advanced imaging make your pain harder to treat?
Pain is designed to protect you. If you touch a hot stove, your nervous system alerts you to your burning hand and you pull your hand away. Pain keeps you safe. And, naturally after such an injury, the nervous system is more sensitive and more protective for a while. Normally though, it returns to a lower baseline of sensitivity.
In that instance, pain made the nervous system more sensitive. Fear does the same thing. If you see an MRI of your spine and discover abnormalities, your body’s natural response is to become more alert to potential danger – which makes your nervous system more sensitive. This is not volitional, but rather a subconscious response. We call it hyper-vigilance. Your brain goes on high alert, tuning in more acutely to pain signals and thus increasing your awareness of it. The heightened sensitivity of your nervous system lowers your pain threshold.
Pain is stressful, and so is seeing something wrong with your spine. Your brain releases cortisol in response to the stress. Cortisol, though initially therapeutic, over time makes you more sensitive, not only to pain, but also to movement, to pressure and to cold. It becomes a vicious cycle with distress causing more pain, and pain decreasing your ability to handle stress. Cortisol also compromises your immune system, and decreases blood flow to postural muscles, so they become tight and sore. ³
Garden-variety low back pain can turn into a nightmare before you know it. But it doesn’t have to.
Why PT first? Physical therapists are experts in musculo-skeletal issues. We are trained to correct musculo-skeletal problems, and help you gradually return to your prior level of function. Having someone guide you through a program that carefully returns you to activity, helps you get stronger and encourages you every step of the way is the key to a good outcome. So start with PT and get back to doing what you love.
- Spine 2012; 37:2012-2021.
- Health Research and Educational Trust DOI: 10.1111/1475-6773.12301.
- Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. Aug 2003; 13(4): 361-370.