- “ Low back pain (LBP) is though to occur in almost 80% of adults at some point in their lives”
This is an article from the 1980’s. It’s been over 20 years since this article was written and these statistics still hold true over time. As much as we have advanced technologically, it doesn’t really seem to be helping the prevalence of back pain. I’ve seen in places where this is called the common cold of musculoskeletal issues because it will affect so many people over the course of a lifetime.
- “…back problems are the most frequent cause of limitation of activity (work, housekeeping, or school) in persons younger than 45 years.”
This is a problem. If I have to take time off of work because of back pain, then there is less food on my table. I’m sure that this holds true for many of those reading this blog. We have to do better. Back pain doesn’t have to disable a person. We need to do a better job of educating the public regarding back pain. There was a recent article that notes that people should try drug-free options first for low back pain. PT is one of those “drug-free” options.
Every day about 1,000 people are treated in the emergency department for misuse of opioids. About 40 people per day die of opioid overdose. These numbers are staggering! It doesn’t have to be so.
- “Only routine examination, postoperative checkups, and upper respiratory tract symptoms surpass back problems as a cause of office visits to physicians.”
This may have changed in the past 20 years. I read recently that back pain accounts for more visits than all other issues except for respiratory tract symptoms (i.e. the common cold). This is a lot of people with back problems. Not many patients are referred to PT. There is an article that reports about 7% of patients seek out PT. When they do get referred, not all PT’s practice with the same treatment parameters. Do your research as to what clinic you are attending, because they are not all the same in regards to cost and effectiveness.
- “A variety of exercise regimens for LBP has been advocated. The three most commonly recommended regimens are (1_ hyperextension exercises to strength paravertebral muscles; (2) general “mobilizing exercises” to improve overall spinal range of motion; and (3) isometric flexion exercises designed to strengthen both abdominal and lumbar muscles, creating a “corset of muscles.”
Lots has changed in the research, but unfortunately not a lot has changed in practice from my point of view. I still see the same “core stability” training done on many patients even though the research doesn’t support one type of “core training” over another. There have been more interventions added to the research and application, such as thrust manipulations, directional preference based exercises, cognitive behavioral therapy and others just to name a few.
- “Several trials shoed no advantage of traction over alternative treatments, but statistical power was not reported.”
This article is over 20 years old! The advice at that time is similar to the current stance based on the research. The problem with this is that there are still many therapists using traction. Saying this differently, there are still some therapists that frequently use traction. This could only be for one of two reasons:
- Ignorance. As much as I would love to say that all therapists are reading journal articles at home, we know that this is not the case. Based on some research, there are therapists that don’t even know how to find the research and if they can find it, they won’t take the time out of their day to read it. This is a problem because it is our profession. I never stop wearing the hat of physical therapist, in the same light as I never stop wearing the hat of husband and father.
- Greed. A therapist doesn’t need to spend much time with the patient while they are on traction. Traction is paid whether the therapist is by your side or not. In this fashion, the therapist can spend time with another patient and charge that other patient for his/her time while the therapist is charging you for traction.
Don’t get me wrong; there are cases in which to use traction. When it is the last viable option to try to get a patient better or to keep the patient from an unwanted surgery. In other words, it is used as a last case scenario. You can see a previous post on traction if you are interested.
- “For these reasons, its (bed rest) value for patients with typical findings of a herniated disk is not disputed…Thus, there is suggestive evidence for the efficacy of strict bed rest for some patients without sciatica…”
Wholly Moley! This has changed dramatically. Bed rest is rarely recommended for anything. The repercussions of spending hours to days in bed far outweigh standing with benign low back pain. This article summarizes the negative effects.
- “Spinal manipulation remains highly controversial, partly because in the United States it is often equated with the practice of chiropractic.”
Physical Therapists are able to manipulate the spine and other areas of the body. No one profession owns this treatment. Chiropractors have done a much better job of educating the public about the treatments that they perform. Don’t be surprised if your therapist wants to perform a manipulation. Lot’s has changed in 20 years.
- “This study did serve to demonstrate that placebo effects with a nonfunctioning stimulator are common”
This is interesting that the thought of TENS (a form of treatment in which pads are placed on a specific body part and an electrical current is introduced throughout the pads in order to reduce pain) 20 years ago was that it could also be the placebo effect that is creating the change. Patients seem to like it in the short-term, but there is major controversy over this intervention. So much so that medicare questions its effectiveness for back pain.
- “The use of corsets, TNS (TENS), and conventional traction are not yet supported by any rigorous trials.”
This was stated 20 years ago! I believe that if you walked into any physical therapy clinic that you would still see these interventions applied to the patient…because insurance companies continue to pay for them. Although there is much research to indicate that these interventions have little to no place in therapy, many times their use is due to the two reasons given above. If you are in a place in which these are the treatments that take up a majority of your sessions, question your therapists. This is the advice given by the professional organization of physical therapists, the APTA.
Excerpts taken from:
Deyo R. Conservative Therapy for Low Back Pain: Distinguishing Useful From Useless Therapy. JAMA. 1983;250(8):1057-1062.