Physical Therapy and Low Back Pain

Evidence on use of physical therapy during an initial episode of low back pain is mixed

Low back pain (LBP) is one of the most common health conditions. About 65-80% of adults will experience it at some point in their lifetime. Many treatment options are available for low back pain. As a result, the outcomes vary. Physical therapy is an effective treatment for low back pain, but not all international guidelines recommend it. In addition, there is mixed evidence on the use of physical therapy for an acute episode of LBP. An acute episode is pain that has lasted for less than four weeks. One study evaluated the relationship between physical therapy and the use of other treatments for patients with back pain. The study focused on the timing of therapy and whether seeing a physical therapist earlier had an impact on their use of other healthcare services.

Patient categories based on when they sought physical therapy treatment

The researchers looked through a large database to identify the medical records of patients over the age of 66 who received treatment for LBP over a one-year period. The analysis included a total of 431,195 patients. Patients were grouped by time that elapsed between their first doctor’s visit for LBP and their first physical therapy visit. The acute treatment group consisted of patients who saw a physical therapist within four weeks. The subacute treatment group saw a physical therapist within four weeks to three months. The chronic treatment group did so in 3-12 months. The researchers counted the episodes of surgery, injections, and back-related doctor visits for each patient. They were trying to determine if the outcomes were better for patients who came to physical therapy sooner.

Low back pain patients should start physical therapy early to avoid other treatments

The results showed that in total, only 16.2% of patients received physical therapy within one year of seeing a doctor for LBP. Of these patients, 52% received physical therapy in the acute period, 18.1% received physical therapy in the subacute period, and 29.9% received physical therapy in the chronic period. Lastly, 11.9% of patients received an injection and 3.1% underwent surgery for their pain. Further analysis revealed that the acute and subacute groups were less likely to have surgery than the chronic group. They were also less likely to have an injection, and had fewer doctor’s visits compared to the chronic group.

These findings suggest that patients who start physical therapy within four weeks are likely experiencing improvements. Therefore, they did not need to return to the doctor or have other treatments like injections or surgery. Although the study did not mention it, this may also mean lower costs for patients. Surgery is an expensive intervention that may only lead to similar outcomes when compared to physical therapy.


Patients with LBP should see a physical therapist, and preferably as soon as possible. Following this route will increase their chances of experiencing a successful outcome while avoiding other risky and expensive interventions. Patients should also consider seeing a physical therapist now in order to get the most out of their healthcare plan. As the year winds down, you should review your health insurance policy and check the current benefit status. IF you have already met your deductible or out-of-pocket maximum for 2019, your costs will be lower or non-existent for physical therapy visits for the rest of the year, until your deductible renews on January 1, 2020.

-As reported in the April ’12 issue of Spine

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