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I often hear from patients in my clinic, “If I had only come to you sooner, I would have been so
much better by now.” This is a nice sentiment, but is this belief actually true? Would you
actually have better outcomes – and faster outcomes – if you came in sooner rather than later?
Let’s jump in to some data on this, specifically with regard to low back pain.
We have gone into several aspects of low back pain here on our blog, but we have never
examined the impact of early treatment. This is an important question for those of us who have
had back pain before, because it is difficult to determine when to seek help. Often, we hope
that if we just hold out a little bit longer, pain will go away on its own. But what if it doesn’t?
We are going to look at two different aspects of medical care for low back pain. The first will be
the impact delaying treatment has upon outcomes, such as pain, disability, mental health and
social function. The second will be the financial implications of delaying care.
Does delaying entry into physical therapy (PT) impact the prognosis of back pain?
In a study by Wand et al in 2004, researchers examined patients who entered PT within the first
six weeks of having symptoms versus those who first went to a primary care physician and then
went to PT 6 weeks later. The researchers found that the group that started therapy sooner had
better outcomes than those who delayed care because they had:
•Reduced disability
•Improved general health
•Enhanced social function
•Better mental health
•Reduced anxiety
•Reduced risk for depression
And this was measured at a six-month follow up! Those people who had delayed care were still
dealing with the above listed complications over six months later. And on top of that, those
who delayed care were 31 percent more likely to develop depression. These are some serious
results, and they should make us consider how quickly we seek help to resolve back pain.
Does delaying entry into physical therapy cost me more money?
Listen, we all do it. We think that if we delay care then the pain will go away on its own and
then we won’t have to fork over the money for a provider visit. Savings, right?? Not so fast. In a
study by Fritz et al in 2012, researchers looked at the financial implications for delaying PT for
back pain.
•Researchers divided people into two groups: those who got PT within 14 days, and
those who got PT after 14 days of symptom onset.
•They found that PT timing was associated with decreased imaging (MRI, x-ray, bone
scan, etc.), fewer physician visits overall (specialists, primary care, etc.), fewer injections
and less medication.
•This all resulted in a cost savings for the PT-early group of $2,736.
This is huge! This completely flips the script that if we wait on our back pain and get care later,
it will save money in the long run. In fact, it can be much more expensive if we do wait. Several
thousand dollars more, in fact. Now, don’t get me wrong – I’m not suggesting that every time
you have a sore back after gardening you set up a next-day appointment with your PT. But this
is certainly food for thought for all of us when it comes to choosing when to get help.
Does early PT care reduce my risk for procedures, such as injections or surgery?
In a study by Gellhorn in 2010, researchers wanted to look at how early PT impacted resulting
medical procedures, such as injections, surgery and recurrent visits due to the same back pain.
Their results are eye opening. There was a strong correlation between delaying PT care and
receiving these procedures. How many of us ultimately want to have back surgery? None! I
frequently hear from my patients that their number one goal for therapy is to avoid back
surgery. This study illustrates that if you are able to get into PT early, you may be able to avoid
unnecessary surgery.
Let’s talk about takeaway conclusions from these articles:
•What could the consequences be for delaying PT for low back pain?
o Consequences can include increased disability, worsened general health,
worsened social function, decreased mental health, increased anxiety and
increased depression.
•How soon should I start PT for back pain?
o The studies are mixed on this but tend to point toward starting within two
weeks. This gives you a full week to see if the pain will work itself out on its own,
and still a week to spare before your outcomes begin to diminish.
•If I want to save money overall, what should I do?
o Getting into PT early has been shown to result in decreased total cost of medical
care, reduced prevalence of surgery and reduced additional medical procedures
performed.
I will leave you with one interesting statistic. In the last study we mentioned, of those patients
with back pain, only 16.2 percent received physical therapy. This is a shocking number, because
so many cases of back pain can be helped quickly! Back pain can be treated, and the sooner we
can start working together, the better!
If you think your back pain needs help, email me and let’s talk.
Until next time,
Ryan