Physical Therapy for Lower Back Pain
Physician or Physical Therapist: Who to see for Low Back Pain
Physical therapists are trained to treat a variety of musculoskeletal conditions but for therapists working in an outpatient clinic, low back pain is a common concern for their clients. This is because low back pain is one of the more common musculoskeletal conditions. A 2018 survey published by the Centers for Disease Control and Prevention (CDC) found that around 30% of adult men and women had experienced low back pain in the three months prior to the survey. Additionally, according to a recent fact sheet from the International Association for the Study of Pain, low back pain has remained the leading cause of years lost to disability since 1990.
What this data tells us is that you are not alone if you are experiencing low back pain. However, the fact that when unaddressed, low back pain can result in disability does not go unnoticed. This is why physical therapists have worked so hard to perfect their treatment approach to low back pain. You have treatment options when it comes to addressing low back pain but this article will help you determine when to seek medical attention and which healthcare professional you might visit first.
DO ALL CASES OF LOW BACK PAIN REQUIRE MEDICAL ATTENTION?
While it can feel pretty awful to experience low back pain, in most cases it is self-limiting. This means that given enough time it will resolve on its own. How much time? That depends on many different factors, all of which should inform your decision to consult a healthcare professional or not. In the case of mild low back pain that resolves with some rest or a temporary reduction in the offending activity and doesn’t return upon resuming full activity, it likely can be handled at home. In the case of severe pain or the presence of these signs and symptoms, however, you should seek care from a medical professional:
Numbness/tingling in the legs: The presence of tingling or altered sensation in the legs indicates pressure or irritation on the spinal nerves. If mild, this is not necessarily a medical emergency but indicates a higher level of care than resting at home is warranted. This could include assessment by a PT or physician.
Numbness or changes in sensation in the groin: This is known as saddle anesthesia and is a sign of cauda equina syndrome, a condition in which the lowest part of the spinal cord is being compressed. This is considered an emergency, especially if it is accompanied by loss of bowel or bladder control and needs to be evaluated quickly by a physician or neurosurgeon.
Radiating pain into the buttocks or legs: As with numbness and tingling, the presence of pain radiating into the buttocks, thighs, lower leg or foot indicates the spinal nerves that carry sensory information from these areas to the lower spine are being irritated. This is not necessarily a medical emergency unless accompanied by signs or symptoms such as fever, significant muscle weakness or loss of bowel and bladder control, for example, but should still be evaluated by a PT or physician.
Recurrent pain: Is your pain getting better with rest but recurs when you resume your activities? This indicates there is an underlying issue that needs more direct attention and failure to address this can lead to worsening of the pain or development of chronic pain. Unless accompanied by the emergent signs/symptoms listed here, a PT is a great first stop for your care.
Weakness in the legs: mild weakness in the legs can occur when there is pressure or irritation on the spinal nerve that supplies motor information to that muscle. This should always be evaluated by a healthcare professional but if the onset of weakness is sudden and it is severe then you should seek medical care right away
Changes in bowel and bladder control: If you are experiencing recent onset of bowel or bladder incontinence or difficulty initiating a urine stream or bowel movement this is considered a medical emergency. Immediate imaging to assess for a condition called cauda equina syndrome is necessary. Do not apply the wait-and-see approach here.
Acute onset pain after a fall or trauma or even after bending over to lift something heavy, especially in those over 50yo: acute onset of back pain after a fall or trauma, especially in those over 50 years old, those with low bone mineral density or those on long-term steroid use or malignancies should always be evaluated by a physician to rule out a fracture.
Presence of spasticity or increased deep tendon reflexes: The presence of either of these characteristics signals your spinal cord may be acutely compressed, a condition which needs immediate attention from a neurosurgeon. You may not realize these signs are present until your doctor or physical therapist examines you. This is often accompanied by significant weakness and changes in sensation in the legs.
Back Pain with fever: the presence of a fever along with acute back pain can indicate a spinal infection or malignancy and needs to be evaluated by a physician
Back pain at night while resting: The presence of new or recent-onset night pain is concerning as it can indicate malignancy. Having back pain during the day that persists into the night as it is difficult to find a comfortable position is different from back pain that occurs primarily at night while resting. Always consult your doctor if you have this symptom especially if it is accompanied by night sweats or fever.
WHEN TO SEE A PHYSICAL THERAPIST VERSUS PHYSICIAN?
In some states, a referral from a physician, PA or Nurse Practitioner is required before being evaluated or treated by a physical therapist. In these cases, you will always see your doctor first. In many states, however, physical therapists can begin care without a doctor’s order. In these states, you will decide where to seek care first. Refer to the section above to help you determine which signs and symptoms need immediate attention by a physician. If you have any of those symptoms, consult your doctor or the emergency room first.
In many cases, however, physical therapists are an excellent and appropriate first stop to address acute or recurrent back pain. A physical therapist will assess your symptoms and screen you for any red flag signs or symptoms that would necessitate referral to a doctor. If any of these are present they may recommend holding off on PT altogether until you can be examined by a doctor or they may ask that you schedule an appointment with your doctor while they begin treating you. Many times, however, you can begin a course of physical therapy to help relieve your pain and address underlying factors that may predispose you to a recurrence of symptoms. Call today to set up an appointment with one of our excellent physical therapists at Evolve to get started.
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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