Low Back Injuries: Physical Therapy vs. Surgery

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Because 80-90% of us will experience back pain at some point in our lives, today's post looks to demystify current management strategies surrounding low back injuries.

Just a normal part of the aging process

Low back pain has multiple potential causes and the source of low back pain can be somewhat of a mystery.  Even the trained clinician may not be able to identify whether the source of pain is stemming directly from a disc, a facet joint or the surrounding soft tissue. Imaging findings of disc degeneration are present in a high number of healthy pain-free individuals, which increases with age. 37% of 20-year-old individuals without pain present with disc degeneration on imaging. Findings of disc degeneration on imaging may just be normal changes taking place in the body and may not be problematic now or in the future.

These eye-opening statistics make me wonder how many unnecessary surgeries have been performed on patients with low back pain presenting with findings of disc degeneration on imaging. The New York Times posted a recent article titled “Why ‘Useless Surgery’ Is Still Popular” discussing this very topic. As healthcare consumers, it is important to be educated regarding the most up to date research and medical advice in order to make informed decisions regarding your healthcare.   

A 2013 study conducted at Thomas Jefferson University Hospital found that patients who pursued surgical intervention to treat degenerative disc disease did not experience greater relief in pain, disability or improved health status, as compared to individuals that received physical therapy.

Not all physical therapy clinics are created equal

In regards to quality of care, not every physical therapy clinic provides high-quality patient-centered care. If you attend physical therapy and spend fifteen minutes receiving heat and electric stimulation and then do a few sets of hamstring stretches, there is a good chance you are not receiving the best evidence-guided treatments available, most likely only delaying your recovery. 

A well-trained, experienced physical therapist will perform a thorough clinical examination and review any available imaging findings in order to determine the best treatment options.  Hands-on manual therapy combined with therapeutic exercise should be incorporated into a treatment plan to manage low back injuries. Not every patient that walks into a physical therapy clinic with complaints of low back pain should be treated the same way. The treatment based classification is an evidence-guided approach to categorize patients with low back pain and has been shown to significantly reduce disability and pain compared with current clinical practice guideline standards.

Low back pain can be severe and discouraging, but in most cases, it is not due to serious injury or disease. It is highly recommended to seek medical advice for injuries, including injuries affecting your lower back.  

If you are in or around the Chattanooga area and dealing with low back pain, Athletic Edge Physical Therapy provides one-on-one evidence-guided treatment sessions from a board certified sport/orthopedic physical therapist, Dr. Brandon Whitworth.