Can you please explain something to me? My sister and I both go to the same doctor. (The doctor doesn't know we are sisters). We both had our first episode of low back pain this past year. She got a referral to physical therapy but I didn't. How come?
The decision to refer a patient with mechanical low back pain to physical therapy is not universal across the United States. And it may not be universal among patients seeing the same physician. But if your physician is following current evidence-based Clinical Practice Guidelines (CPGs), then each patient would be evaluated and referred according to that plan. The CPGs recommends against early referral for treatment. Early symptoms of generalized low back pain that are not caused by infection, tumor, or fracture should be managed with a very short period of rest followed by activity as tolerated. Self-management skills of this type are advised. Physical therapy would be indicated more for the person who does not recover following the CPGs. However, a recent study from the University of Utah has brought to light that early physical therapy (PT) treatment results in lower overall health care costs. Patients who have mechanical low back pain and see a PT within the first two weeks have less chance they will need advanced imaging (CT scans or MRIs). It is also less likely that they will have more invasive treatment (surgery, injections). It's likely there are specific reasons why your physician treated you differently than your sister. But you would have to ask to find out more about his or her thinking in this decision-making process. Other factors can come into play such as age, general health, fear-level (anxiety), and the presence of other health problems (e.g., diabetes, heart disease, cancer). The value of physical therapy in the treatment of low back pain remains an area of debate and study. This particular study did not examine which patients should be referred to physical therapy or the patient outcomes for those who were referred early versus late. Further studies are needed to help determine who should be referred and how soon after diagnosis.
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