Low back pain is extremely common. About one half of all working Americans experience symptoms at least once a year, and roughly 31 million are affected by it at any given point in time.
Dealing with low back pain can be troublesome. Typical movements like bending over to pick something off the ground or twisting your torso can cause pain, and this will cause you to be less mobile overall. Therefore, many patients with low back pain will start searching for answers. What is causing the pain?
Sadly, searching for a low back pain diagnosis is complicated and often does not lead to the outcomes that most patients hope for. And in many cases, it can do more harm than good. When seeking a diagnosis, many patients will have an imaging test (X–ray, MRI, or CT scan) performed, either by the doctor’s order or their request. These types of tests are essential for diagnosing numerous conditions throughout the body, but when it comes to low back pain, their usefulness is limited. Many “abnormal” results from imaging tests could be simple age related changes that are not contributing to a patient’s pain. However, some practitioners will still treat the “problem” nonetheless, which may lead to an unnecessary medical procedure.
Clinical guidelines and experts have long recommend that imaging tests for low back pain should only be performed if one or more “red flags” is identified during an examination. Red flags for low back pain include the following:
- Loss of bladder or bowel control
- Signs of severe or worsening nerve damage
- Serious underlying problems like cancer or spinal infections
- Unexplained weight loss
- Abnormal reflexes
- Recent serious fall or injury
- Worsening numbness or weakness in one leg
If none of these red flags are present, having an imaging test is not recommended because it’s not likely to provide any valuable information or lead to better outcomes. Yet many patients with low back pain and no red flags still undergo MRIs of their spine.
Greater use of healthcare services leads to higher costs for patients undergoing MRIs
A 2015 study illustrates the implications of unnecessarily having an MRI for low back pain instead of seeing a physical therapist. For the study, researchers analyzed data from the medical records of 2,893 patients with low back pain that were identified through a comprehensive search. Of these patients, 841 received treatment outside of primary care within the first six weeks of their diagnosis, with 46% receiving a diagnostic test—usually an MRI—and 45% receiving physical therapy.
A comparison of these two groups showed that those who received a diagnostic test first utilized significantly more healthcare services than those who underwent physical therapy first. For example, patients who first received a diagnostic test were more than 3 times more likely to undergo surgery, almost 4 times more likely to have injections, and about 7 times more likely to see a spine surgeon compared to those who saw a physical therapist first. As a result, healthcare costs for low back pain over one year were about $4,700 higher when imaging was performed first due to the increased use of these healthcare services.
This study clearly shows why it’s usually best for patients with low back to visit a physical therapist early after noticing pain rather than going to a primary care physician or specialist, who may be more likely to order a diagnostic test. With this in mind, we strongly recommend that you consider seeing a physical therapist if low back pain is bothering you and to avoid the temptation of relying too heavily on a diagnosis for the reasons we’ve described here.
North Penn Physical Therapy specializes in one on one treatment for back pain. Feel free to contact us for more information.
