Back

Why do you think doctors wait so long to send people to physical therapy for their back pain? If I had gone sooner than later, I might not be so laid up now. The therapist hasn't said that to me but I can tell from how much better I am after each session that we should have started sooner.

The current best practice (based on evidence from many studies) is to recommend activity modification while still remaining active in the early stages of back pain. Eighty per cent (80%) of patients with acute low back pain from a mechanical cause (i.e., not an infection, tumor or fracture) get better in two weeks' time without intervention. Ten per cent take a little longer and only the reamining 10 per cent go on to develop chronic pain. Studies are ongoing to figure out (predict) which patients fall into the three categories (those who recover in two weeks, those who need a little more time, and those who should receive active treatment earlier than later). A recent study by a group of therapists has shown us that physician referral patterns are a factor in patients outcomes. Occupational medicine physicians are more likely to refer earlier and those patients do show better results with earlier treatment. The goal is to get workers back on the job and reduce lost work time. Some of the reasons for early referral may have to do with consumer choice (the patient requests referral to a therapist). The timing of some referrals may be based on reimbursement. Patients in preferred provider organizations (PPOs) and health maintenance organizations (HMOs) tend to receive earlier referrals, too. Although it's true that patients who see a physician first may not make it to the therapist at all (or in a very delayed fashion), the law in most states does allow you to go to the therapist without seeing your physician. So, depending on where you live (most states do have Direct Access), you can refer yourself. Physical therapists are trained to screen for medical causes of back pain and will refer you to a physician if your history and symptoms are not consistent with a mechanical cause of low back pain. Therapists are also aware of (and follow) the current clinical practice guidelines that recommend minimal treatment but active guidance.

« Back