In an April 2017 Annals of Internal Medicine Journal issue, the American College of Physicians described their guidelines and recommendations developed for treatment of patients with acute, sub-acute and chronic low back pain. Those clinical guidelines for physicians recommend physical therapy (PT) interventions over invasive treatments and pharmacological interventions as primary options for all back pain.
Studies suggest that about 80 percent of American adults experience low back pain (LBP) at some point in their lifetimes, and about a quarter of individuals surveyed describe having some form of back pain in the last three months. Most back pain is acute and will typically resolve itself within a few days or weeks, but research has also shown a quicker recovery with better quality of life outcomes when PT is initiated earlier.
Based on the guidelines provided, most acute and sub-acute LBP will improve without treatment overtime. Therefore, the first choice for those conditions should be interventions such as moist heat, massage and spinal manipulation. The second recommendation was specifically for patients with chronic low back pain. Once again the recommendation called for choice of nonpharmacologic treatment such as multidisciplinary rehabilitation and exercise, as well as other PT modalities and interventions such as low-level laser therapy, motor control exercises and spinal mobilization. Opioids should only be considered after non-pharmacologic therapies have been exhausted and deemed ineffective.
Previous research has shown effectiveness of physical therapy interventions in treatment of all back conditions. Physical therapy should be individualized and patient centered, specific to patient’s symptoms and functional limitations. Generic interventions may still reduce pain and disability, but may not yield optimal outcomes, as treatment should be based on the cause of the symptoms. In fact, symptoms may worsen if the exact cause is not properly established.
A skilled physical therapist is capable of accurately assessing the cause of LBP through history taking and physical examination. Once an accurate cause has been established, conservative PT treatment may be initiated to decrease symptoms, facilitate return to normal function and improve quality of life. Early intervention is also critically important in order to decrease the potential for longer disability and pain.
Dr. Moczerniuk is a doctor of physical therapy, member of American Physical Therapy Association, and the clinical director at db Orthopedic Physical Therapy of Manalapan, located at 120 Craig Road, Suite 2. Dr. Moczerniuk can be reached at 732- 462-2162 or via email at Jerry@dborthopt.com. For more information, visit www.dborthopt.com.