Although you may not pay it all that much attention, the neck has a pretty crucial job to perform. It provides support for the head and allows movement in a variety of directions so you can better see and navigate the world around you. But as we discussed in our last newsletter, the neck is also an extremely common site of pain on account of how frequently it’s used, and this pain can stand in the way of a satisfactory quality of life.

A wide array of factors can contribute to the development of neck pain in any given individual. Unfortunately, some of these factors are completely out of your control, like the age-related changes to the cervical spine that make certain neck conditions more likely to occur. These are considered non-modifiable risk factors and simply have to be accepted since nothing can be done to alter them. On the other hand, modifiable risk factors are those that each individual has the capacity to change. And in doing so, you have the power to reduce your risk for encountering neck pain.

Two modifiable risk factors that can strongly influence your chances of getting neck pain relate to where you sleep and work. These are the two places that many of us spend the majority of our time on any given day, which means that how you position your body—particularly your neck—in each of them warrants your attention. Below are some of the best tips to improve your posture and positioning at your bed and at your work desk to lower your risk for neck pain.

Tips for better posture while sleeping

We spend roughly one-third of our lives sleeping, so the habits we develop in both our sleeping patterns and in how our beds are set up can have a major impact on the rest of the day. Sleeping in the wrong position or on a pillow that’s not supportive enough can lead to neck pain immediately or may contribute to it gradually over time. Try the following to optimize the setup of your bed:

• Avoid stomach sleeping: the best sleeping position is on the back, followed by the side, while stomach sleeping turns the neck to the side and can lead to neck pain; sleeping positions are often established earlier in life and can be difficult to change, but trying to start a night’s sleep on the back will increase your chances of remaining in that position
• Use the right pillow: make sure your pillow is of the appropriate firmness for your neck; different types of pillows are better for different individuals, but a good rule of thumb is to try to use a pillow that keeps your upper spine in neutral alignment, which means the natural curve of the neck is supported and maintained; feather and memory foam pillows may be helpful, while pillows that are too high or too stiff should be avoided
• Maintain healthy sleeping habits: getting the recommended 7–9 hours of sleep each night is associated with a host of health benefits, one of which is a reduced risk for neck pain

Tips for better posture at your work desk

For the many individuals that work in an office of any sort, another significant chunk of each day is spent sitting at a desk. As with bed setups, the way in which a workstation is arranged affects the neck and can play a part in the development of pain. To ensure that your workstation is not adding any strain to your neck, we recommend the following:

• Make sure your computer is at eye level and not too close or far away from you; you shouldn’t have to crane your neck down or strain your eyes to look at it
• When seated, the feet should be flat on the floor and the back of the chair should be in an upright position
• Keep the keyboard directly in front of you, close by, and at a height so your shoulders are relaxed, elbows slightly bent, and wrist and hands straight
• Consider using a document holder placed next to your computer to avoid constant neck movement when switching between the two

Other

• Avoid neck strain when using your phone by raising it to eye level, taking frequent breaks, and minimizing phone time
• Use a headset or headphones if you are on the phone frequently
• Use a neck pillow for flights and long car rides
• Regularly perform stretching and strengthening exercises for the neck to keep it flexible and strong

In our next newsletter, we’ll look into some of the ways you can alleviate neck pain on your own if it’s bothering you right now.

Most of us can recall one or more occasions when the day got off to a rough start because of a stiff neck. This can be explained by the fact that neck pain ranks among the most common types of pain you can get. Statistics vary on just how many people encounter neck pain, but recent evidence suggests that its lifetime prevalence is between 20—70% and that 10—20% of individuals are affected by it at any given time. As we’ll show you, the likelihood of having neck pain also increases as you get older, and different conditions are more common at certain ages.

There are seven bones (vertebrae) in your neck, which are collectively referred to as the cervical spine. These vertebrae are called C1—C7, with C1 being the first vertebra at the base of the skull and C7 being the lowest vertebra around the chest area. Providing further support for these vertebrae are intervertebral discs, which sit between each bone to cushion them and absorb shock during impact. The cervical spine also consists of numerous joints that allow for an impressive range of motion that you can notice any time you nod, turn, or rotate the head in any direction. Unfortunately, this wide range of motion is one of the main reasons neck pain is so prevalent.

Sprains and sprains are most likely to occur in children and young adults

Throughout childhood and adolescence, the chances of experiencing neck pain are fairly low, but this is not to say that this age group is immune. If neck pain does occur in children, it is most likely due to strains or sprain of the muscles or ligaments in the neck. The reason is that although neck muscles and ligaments are flexible at these ages, they can still get pushed beyond their limits. When this does happen, it is typically the result of maintaining bad postures for extended periods of time or sleeping on the neck wrong. Patients with neck strains and sprains will probably complain of pain and discomfort in the back, side, or front of the neck that limits their movement and activity.

Age—related changes begin playing a role in middle age

Neck strains and sprains remain fairly common later in life, but several other neck conditions also enter the fold. The primary reason is that certain unavoidable, age—related changes begin to occur in the cervical spine. For example, the structures that make up the neck become weaker, the intervertebral discs lose some of their height, and the joints in the neck adapt to other changes in the body. Eventually, these changes make the structures of the neck slightly less effective, and this can often lead to the development of other neck conditions. Some of the most common disorders include:

• Osteoarthritis: this condition results from the ends of bones in the neck losing protective cartilage
• Spondylosis: a general term used to describe any pain related to age—related changes in the spine
• Herniated disc: this occurs when some of the jelly—like substance in an intervertebral disc protrudes out, which may cause pain and other symptoms that radiate from the neck

These types of issues typically develop between the ages of 40–60 but can be seen even earlier in certain individuals. Symptoms also range significantly, as some people experience regular pain and physical limitations, while others may have signs of age—related changes but fail to notice any impairments.

Similar issues plus additional complications may await in older age

For adults over the age of 65, age—related changes continue to occur and may begin to become more advanced in some cases. This means that conditions like osteoarthritis and spondylosis are even more likely and may be more severe for some individuals. Other conditions like spinal stenosis and osteoporosis are also more common in older age and can therefore be added to the list of possible neck problems. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the structures within it, while osteoporosis is a condition that causes bones to become weak and brittle. Other mobility limitations could make neck—related issues even more of an impairment for the elderly, but all of these problems are still treatable.

What’s important to understand is that while there is nothing that can be done to stop the aging process, there are a number of changes you can make to your everyday life that can significantly reduce your chances of experiencing neck pain. We will discuss these tips in our next newsletter.

October is National Physical Therapy Month, which is an annual opportunity for physical therapists nationwide to campaign and speak out about their profession. The goal of the campaign is to increase public awareness of the important role that physical therapy plays in reducing pain, improving mobility, and encouraging a healthy lifestyle for patients. In honor of this important profession, we’d like to walk you through a brief summary of how physical therapy has evolved over the years and some of the many conditions it is used for in treatment.

The roots of physical therapy can be traced back to approximately 435 BC, when Hippocrates—typically referred to as the “Father of Medicine”—utilized techniques like hydrotherapy (water–based treatments), massage, and manual (hands–on) therapy on patients. But it wasn’t until the early 20th century that the modern physical therapy practices we know today began to take form.

Two major historical events played a significant role in the development of physical therapy: the devastating polio epidemic and the impact of several major wars throughout the 20th century.

Call to action from the polio epidemic

The first major outbreak of polio hit the U.S. in 1916 when over 9,000 cases occurred in New York State alone. At the time, polio was treated with long–term splinting and bed rest, but this approach caused most patients to experience severe weakness and decreased flexibility that was impairing their mobility. As public and private experts recognized that these current methods were grossly insufficient, they called for a more effective strategy through a national program that would train individuals to administer better interventions to polio patients.

This resulted in several schools of physical training and allied therapies to implement programs that would produce “physical reconstruction aides,” which were later renamed physical and occupational therapists. These aides would prescribe various treatments—like massage and hydrotherapy—as prescribed by surgeons and other doctors, and numerous strides in the profession were made during this time. Among these was the development of manual muscle testing to assess muscle strength, which also helped to create techniques designed to reeducate weaker muscle.

Response to World War I through the Vietnam War further molds the profession

World War I was raging around the same time, with the U.S. entering in the spring of 1917. Consequently, over 200,000 wounded troops returned home and in need of structured treatment to rehabilitate them. In response, a plan was formulated that led to the creation of a group comprised of reconstruction aides/physical therapists who would provide exercise programs, hydrotherapy, and other modalities, and massage for these patients to help them regain their lost abilities. A partnership between physical therapists and the medical and surgical community was also forged in the 1920s, which further increased recognition and support of the profession.

Physical therapists’ services were also required during World War II, which sent home a multitude of soldiers with amputations, burns, fractures, and nerve and spinal cord injuries. The U.S. Army once again met this need by implementing plans to recondition these wounded soldiers through physical retraining, vocational rehabilitation, and psychological support. Research into the use of electrical stimulation during this time also helped physical therapists learn that their efforts should focus not only on preventing muscle atrophy but also in building back muscle mass and strength.

The 1950s saw physical therapists progress from technicians to professional practitioners, primarily through the American Physical Therapy Association establishing a professional competency examination in 1954. In the '50's with the Korean war, and then thru the 60's and 70's with the Vietnam war there again was a large number of wounded soldiers requiring structured treatment. This further advanced the profession with new interventions intended to rehabilitate surgical wounds, increase range of motion, and restore strength and flexibility, particularly after serious burns. In addition, the Vietnam War was the first time physical therapists were allowed to treat patients with neurologic injuries without a doctor’s referral due to a shortage of surgeons.

Additional progress into the present

The reach of physical therapy has continued to expand in the years that followed and into the 21st century, it is now recognized as an integral part of healthcare for patients with a wide variety of injuries and painful conditions. Physical therapists are movement experts whose efforts remain focused on improving the quality of life of their patients through education, hands–on care, and prescribed exercises. They are capable of effectively managing practically any condition associated with pain or impaired mobility, and they do so with personalized treatment programs that are unique to each patient. The list of the conditions they treat includes, but is not limited to, the following:

• Arthritis
• Back and neck pain
• Foot and ankle injuries
• Hand and wrist injuries
• Knee pain
• Shoulder injuries
• Sprains, strains, and fractures
• Work–related injuries
• Osteoporosis
• Headaches
• Surgery rehabilitation
• Balance and vestibular conditions
• Stroke rehabilitation
• Cancer rehabilitation
• Fall–prevention programs
• Sports injuries

We hope you enjoyed learning about the origins of physical therapy in this abridged history of the practice.

All month long, we’ve been honoring National Physical Therapy Month by educating our readers about how physical therapy works and the many ways it can benefit you. In the third newsletter of our series, we offer a brief overview of the crucial role that physical therapy frequently plays in the management of orthopedic problems.

Orthopedics is a branch of medicine that addresses issues related to the musculoskeletal system, which includes the bones, joints, ligaments, tendons, and muscles. Issues that develop in these parts of the body are usually due to a traumatic incident, overuse, or natural bodily changes, and they can be treated in a number of different ways. The most effective orthopedic care requires several important components, and physical therapy is considered an integral facet at many stages of the treatment process.

With or without surgery, physical therapy is typically involved

When most people hear the word ‘orthopedics,’ the first thing that comes to mind is often an orthopedic surgeon. But while surgery may be recommended for severe and/or long–term injuries and conditions—especially for very active athletes—it is absolutely not necessary in all cases. Treatment approaches for orthopedic injuries include both conservative management strategies (like medications, injections, and physical and occupational therapy) as well as more invasive options like surgery.

The main reason that physical therapy is a core component of orthopedics and why the two overlap so much is that they both work towards the same overall goals. When a patient suffers from an orthopedic injury, certain parts of their musculoskeletal system are disrupted, which will lead to pain and a limited ability to function normally. The goal of both physical therapy and orthopedics is to address and fix these problems within the musculoskeletal system so the patient can go on to function fully once again.

Physical therapy can therefore be utilized in a few ways to address an orthopedic injury:

• A patient experiences an orthopedic injury and goes directly to a physical therapist
• A patient gets injured and sees an orthopedic physician (orthopedist) who then refers the patient to a physical therapist
• The orthopedist recommends surgery for the patient, and then prescribes a course of physical therapy prior to the procedure (“prehabilitation”)
• The orthopedist recommends surgery and prescribes physical therapy as part of the post–surgical rehabilitation program

How a physical therapist addresses the patient’s orthopedic injury depends on the injury present and at what stage treatment begins, but most treatment programs share a number of similarities. For example, all treatment programs are based on an initial evaluation of each patient for strength, flexibility, balance, posture, and several other physical measures that will provide a clearer picture of their condition for the physical therapist. From there, the therapist will develop a sense of the goals the patient would like to achieve then shapes treatment around their injury, abilities, and goals.

If physical therapy is initiated exclusive of surgery, therapists will aim to improve strength, flexibility, and functioning through various exercises, pain–relieving interventions, and hands–on techniques from the therapist. A primary goal is always to avoid surgery, but it may be necessary for patients that fail to improve or have severe injuries. If this is the case, the treatment program will either prepare a patient for what’s to come after the procedure is completed or help speed up the recovery process and bring the patient back to full strength as quickly and safely as possible. Once again, it’s all about correcting any musculoskeletal problems and rebalancing the body, so that every patient can move and function normally after the procedure.

Returning to pre–injury fitness levels

Another goal of physical therapy for orthopedic conditions is to help each patient return to their prior level of physical activity. For those who were actively involved in sports or a regular fitness regimen, this will typically require targeted functional training that mimics the movements and patterns involved in the particular activity. Returning to these levels can be challenging, especially when surgery is involved, but it serves as the guiding principle of all physical therapy–based strategies. And through dedication and commitment to the prescribed management program, most patients can expect to eventually reach their pre–injury capabilities once again.

Certain physical therapists actually specialize in orthopedic care and work exclusively with orthopedic surgeons, but most physical therapists are capable of treating the wide range of orthopedic injuries. Therefore, if you’re currently affected by an orthopedic injury of any type, there’s a strong chance that physical therapy will play a major role in your recovery. To reduce your chances of needing surgery, see a physical therapist first, and fast, and see for yourself what a personalized path to orthopedic care can do for you.

October is National Physical Therapy Month, which gives physical therapists nationwide an opportunity to highlight and celebrate the countless benefits that our profession can provide. In honor of this important month, we’d like to discuss the dangers of using opioids for pain and explain why physical therapy is a much safer and more effective option.

Any amount of pain can be a nuisance to your life, especially when it lasts for a while. Everyone deals with pain differently, and there are a number of options available to treat it. One is narcotics and pain medications like opioids, which have been garnering significant national attention on account of the devastating problems that they have played a major role in creating.

Opioid use in the U.S. is alarmingly disproportionate to the rest of the world

In addition to the coronavirus pandemic, the U.S. has also been encumbered by an opioid epidemic for many years due to the over–prescription of these drugs. Although our country represents less than 5% of the world’s population, we consume more than 80% of the global supply of opioids. The number of opioid prescriptions increased by 600% from 1997–2007, and there has been a threefold increase in the abuse of these drugs over the past few years.

These shocking figures show just how big of a problem opioid use is in the U.S. While there are many patients that truly need opioids due to pain that can’t be treated with anything else, many others are using them for the wrong reasons. These individuals are usually looking for a “magic bullet” to immediately fix them, and opioids can often give them the most immediate short–term relief, even if it doesn’t solve their problem. In other cases, patients are prescribed opioids to help them deal with pain following surgery. Sadly, this can also have some negative effects.

Studies have shown that patients who continue to use opioids after surgery have worse outcomes than those who don’t. This has been seen with a greater number of symptoms, more stress, more disability, and higher tolerance for opioids. This higher tolerance for opioids is very dangerous and can lead to addiction if the drugs are taken for long enough. This is why many people who are prescribed opioids after surgery or for an injury eventually develop addictions. They often become too reliant on the drugs during their recovery and are unable to stop taking them afterwards.

Physical therapy effectively addresses pain instead of ‘masking’ it

Physical therapy, on the other hand, offers a wide range of benefits that far outweigh any risks involved. Unlike narcotics, which are only meant to mask the perception of pain, physical therapists prescribe interventions that are designed to improve the mobility and stability of a painful area. In effect, this approach works towards correcting the structural issues responsible for the patient’s pain in a safe and gradual manner.

In addition, physical therapy teaches patients how to accurately perform a variety of exercises on their own to target their painful condition. All patients are instructed to continue performing these exercises after completing their treatment program, which gives them the opportunity to keep improving and experience a successful long–term outcome.

Physical therapy is appropriate for all ages and activity levels, and it can be used to address just about any condition, injury, or disorder that affects movement. For these reasons, we strongly recommend seeing a physical therapist quickly if pain is getting in the middle of you and the things you love. Following this route will also reduce your chances of being prescribed opioids at any point.

In our next newsletter, we discuss the ways that physical therapists can help you overcome orthopedic problems and return to your desired level of physical activity.

National Physical Therapy Month is celebrated every October, with its focus on educating the public about how physical therapy can change patients lives for the better. To work towards this goal, we’d like to share our insight on why physical therapy is usually the best treatment option available if you are in pain of any sort.

Moving more will lead to less pain

We all deal with bouts of pain from time to time, which can often make tasks that are otherwise mindless and routine become difficult and challenging. Regardless of the level of pain, most individuals will need to make adjustments of some sort to the way they navigate the world throughout each day. When this is the case, exercising or moving your body in ways that might aggravate pain may sound like the last thing you’d want to do to get better, but targeted movement is actually the key to improving.

There are a great many conditions that can result in a painful sensation, which is usually your body’s way of telling you that something isn’t working properly. From back and neck pain to arthritis, frozen shoulder, and plantar fasciitis, pain can manifest in a multitude of ways. And for most individuals who find themselves in pain, the temptation is usually to move as little as possible to avoid making it worse. Unfortunately, moving less and reducing physical activity levels will have the opposite effect.

Despite your natural tendencies, moving the painful parts of your body in a structured manner will go on to alleviate pain in most cases. This is where physical therapy comes in.

The role of a physical therapist is to first identify the source of your pain and extent of your limitations by performing a thorough evaluation. Based on these findings, the physical therapist will then design a personalized treatment program that addresses your impairments and considers your physical abilities, preferences, and goals. And though it may be hard to find the motivation to see a physical therapist at first, doing so when your condition is in an aggravated state helps them better understand what’s going on.

Prescribing a program that works for each patient

Physical therapists are movement experts who are proficient at selecting the most appropriate interventions for each patient based on their unique condition. Programs will vary depending on a number of factors, but most will consist of some—if not all—of the following components:

• Patient education
• Pain–relieving modalities like ice and electrical stimulation
• Stretching exercises to increase flexibility
• Strengthening exercises to build back strength
• Manual (hands–on) therapy techniques like massage, mobilization, and manipulation
• Functional training, especially for athletes and worker’s compensation patients
• Balance and vestibular training
• Posture correction

Physical therapists will also encourage regular physical activity (about 150 minutes of moderate–intensity exercise or 75 minutes of vigorous–intensity exercise per week) to increase your strength, endurance, and joint stability and flexibility. Frequent exercise will also help control your pain and allow you to maintain an ability to move and function to your full capacity. Physical therapists will monitor your activity progress and offer continual feedback as you progress to ensure that you’re moving at the right pace and not overdoing it. They will also modify your program if needed to keep your pain levels at a minimum, so you can continue to work independently towards less pain and more function.

As with many things, the first step is the hardest, but it can also be the game–changer you’re seeking. So, if pain is currently holding you back and you’re interested in making a change, we strongly encourage seeing a physical therapist soon for a personalized approach to treatment that will get you moving again, and quickly.

In our next newsletter, we explore how physical therapy stacks up against opioids, another pain management option that usually does more harm than good.

As we discussed in our second newsletter this month, diagnostic tests like X–rays should only be performed when a red flag is detected, meaning that the healthcare professional notices signs of a potentially serious underlying condition during the initial evaluation. Despite this, many X–rays continue to be performed on patients with conditions like back pain even when no red flags are identified.

Large groups of chiropractors, for example, including the International Chiropractic Association, promote the use of routine or repeat X–rays to assess the structure and function of the spine. This practice has been used for over 100 years, and it’s unclear if doing so is associated with any benefits for patients with back pain. With this in mind, a study was conducted to evaluate whether chiropractors’ routine or repeat use of spinal X–rays without red flags have any noticeable impact on patients’ outcomes.

This particular study was a systematic review, in which researchers performed a thorough search for any studies with data on patients who visited a chiropractor and were referred to undergo an X–ray of any region of their spine in the absence of red flags. They were specifically interested in patient outcomes that were associated with chiropractic approaches that used these X–rays for diagnosing or assessing the patients’ condition. Once identified, they analyzed the results of these studies to determine if there was a clinical utility of X–rays for patients with back pain. Clinical utility was defined as “the degree to which the use of a test is associated with changing health outcomes through diagnosis or selecting an appropriate treatment.”

No evidence found in 23 studies to support the use of X–rays

The search process originally identified 959 articles, and researchers screened 176 of these to land on a total of 23 studies that met the necessary criteria and were included in the review.

Researchers were unable to identify any studies that investigated the clinical utility of spinal X–rays in the absence of red flags for evaluating the spine. Similarly, no studies were identified that investigated whether findings from repeat spinal X–rays are valid markers of significant changes when monitoring patients with back pain. These findings suggest that X–rays of the spine without red flags do not appear to be beneficial for patients. The study also points out that X–rays expose patients to some radiation, and although the amount used in a single X–ray is generally considered to be safe, no dose of radiation exists that is not without risk. This risk also increases proportionally with the dose, meaning that X–rays could pose dangers for patients when used repeatedly over time. Taken together, given the lack of benefit to patients and associated radiation risks, this study provides additional evidence as to why X–rays should not be recommended for patients with back pain in the absence of red flags. Doing so exposes patients to harmful radiation and does not appear to have any noticeable impact on their clinical outcomes.

Therefore, patients with back pain are encouraged to not request X–rays and other diagnostic imaging tests from their doctors. They should also be sure to discuss the risks, benefits, and costs of any test being ordered to diagnose or assess their condition before proceeding.

Additionally, patients should strongly consider seeing a physical therapist first rather than their primary care doctor or a surgeon. Physical therapists avoid the overuse of diagnostic tests and only order them when it is deemed absolutely necessary in light of the associated risks and costs. Instead of spending time in search of a diagnosis, they will get patients started on a treatment program from the get-go that will address their limitations and teach them to use their own movements to overcome their pain and disability. So if you are currently dealing with back pain or any other musculoskeletal condition, we urge you to contact our clinic to schedule an initial visit and get started on your path to recovery.

As we explained in our last newsletter, diagnostic imaging tests can be a vital tool that helps doctors more clearly understand what’s happening in the body in order to reach or confirm a diagnosis. But simply because these tests are helpful does not mean they should be used at all times, or even frequently. For musculoskeletal disorders—like back, neck, and knee pain—imaging tests should be used when certain criteria are met, yet statistics on their use paint a much different picture.

The overuse of diagnostic testing for musculoskeletal disorders is part of a much larger trend in the healthcare industry. According to one article, about $800 billion of healthcare spending is spent on unnecessary diagnostic tests, procedures, and extra days in the hospital. For musculoskeletal disorders, back pain typically garners the most attention because it is so common and because it serves as one of the clearest examples of excessive diagnostic testing use.

Low back pain is one of the most common overall ailments and will affect up to 80% of individuals at some point in their life. Imaging tests are only recommended when a “red flag” is present, which include signs of severe or worsening nerve damage, serious underlying problems like cancer or spinal infections, unexplained weight loss, loss of bladder or bowel control, and abnormal reflexes. If none of these red flags are present, an imaging test is not usually required, but many patients with back pain continue to have MRIs of their spine for one reason or another.

Despite the existence of guidelines that recommend against MRIs, except for in these rare cases, there is data that shows many patients with back pain are initially being prescribed diagnostic imaging tests without first attempting less expensive and less invasive treatments like physical therapy. In fact, one study estimated that the use of MRIs for low back pain increased by as much as 300% between 1994-2006. And while it may seem as if the overuse of these helpful tests is generally harmless, the inverse is actually true.

For starters, imaging tests—particularly MRIs and CT scans—are extremely expensive. The average cost of an MRI is $1,119, with some costing as much as $3,000, which is significantly higher than any other comparable countries. CT scans and X-rays also expose patients to potentially harmful levels of radiation that could otherwise be avoided. But perhaps most importantly, imaging tests can do more harm than good for many patients. This is because they don’t always identify the cause of patients’ pain—especially for low back pain—and often reveal “abnormalities” unrelated to the pain that may be misconstrued as a cause. An important study highlights why this is true, as it reviewed the MRIs and CT scans of more than 3,000 individuals with no signs of back pain. Results revealed the following:

• 20-year-olds: 37% had “disc degeneration” and 30% had “disc bulging”
• 50-year-olds: 80% had “disc degeneration” and 60% had “disc bulging”
• 80-year-olds: 96% had “disc degeneration” and 84% had “disc bulging”

These results show that disc degeneration and disc bulging are extremely common in most people without back pain, and the likelihood of having these “abnormalities” increases significantly with age. Therefore, many patients with back pain may be told that they have disc degeneration or disc bulging and believe this to be the reason for their pain, while the truth is that it is likely a sign of the natural aging process instead.

Another extremely unfortunate consequence of this testing is that many patients go on to receive invasive, dangerous, and expensive interventions based on the results of their tests, even if the procedure won’t actually resolve their pain. In our next newsletter, we’ll explore the repercussions of overusing diagnostic imaging tests in more detail and explain why this can all be avoided by seeing a physical therapist first.

As we explained in our last newsletter, diagnostic imaging tests can be a vital tool that helps doctors more clearly understand what’s happening in the body in order to reach or confirm a diagnosis. But simply because these tests are helpful does not mean they should be used at all times, or even frequently. For musculoskeletal disorders—like back, neck, and knee pain—imaging tests should be used when certain criteria are met, yet statistics on their use paint a much different picture.

The overuse of diagnostic testing for musculoskeletal disorders is part of a much larger trend in the healthcare industry. According to one article, about $800 billion of healthcare spending is spent on unnecessary diagnostic tests, procedures, and extra days in the hospital. For musculoskeletal disorders, back pain typically garners the most attention because it is so common and because it serves as one of the clearest examples of excessive diagnostic testing use.

Low back pain is one of the most common overall ailments and will affect up to 80% of individuals at some point in their life. Imaging tests are only recommended when a “red flag” is present, which include signs of severe or worsening nerve damage, serious underlying problems like cancer or spinal infections, unexplained weight loss, loss of bladder or bowel control, and abnormal reflexes. If none of these red flags are present, an imaging test is not usually required, but many patients with back pain continue to have MRIs of their spine for one reason or another.

Despite the existence of guidelines that recommend against MRIs, except for in these rare cases, there is data that shows many patients with back pain are initially being prescribed diagnostic imaging tests without first attempting less expensive and less invasive treatments like physical therapy. In fact, one study estimated that the use of MRIs for low back pain increased by as much as 300% between 1994-2006. And while it may seem as if the overuse of these helpful tests is generally harmless, the inverse is actually true.

For starters, imaging tests—particularly MRIs and CT scans—are extremely expensive. The average cost of an MRI is $1,119, with some costing as much as $3,000, which is significantly higher than any other comparable countries. CT scans and X-rays also expose patients to potentially harmful levels of radiation that could otherwise be avoided. But perhaps most importantly, imaging tests can do more harm than good for many patients. This is because they don’t always identify the cause of patients’ pain—especially for low back pain—and often reveal “abnormalities” unrelated to the pain that may be misconstrued as a cause. An important study highlights why this is true, as it reviewed the MRIs and CT scans of more than 3,000 individuals with no signs of back pain. Results revealed the following:

• 20-year-olds: 37% had “disc degeneration” and 30% had “disc bulging”
• 50-year-olds: 80% had “disc degeneration” and 60% had “disc bulging”
• 80-year-olds: 96% had “disc degeneration” and 84% had “disc bulging”

These results show that disc degeneration and disc bulging are extremely common in most people without back pain, and the likelihood of having these “abnormalities” increases significantly with age. Therefore, many patients with back pain may be told that they have disc degeneration or disc bulging and believe this to be the reason for their pain, while the truth is that it is likely a sign of the natural aging process instead.

Another extremely unfortunate consequence of this testing is that many patients go on to receive invasive, dangerous, and expensive interventions based on the results of their tests, even if the procedure won’t actually resolve their pain. In our next newsletter, we’ll explore the repercussions of overusing diagnostic imaging tests in more detail and explain why this can all be avoided by seeing a physical therapist first.

When dealing with pain of any sort, physical therapists and medical doctors have a number of tools at their disposal to help determine the cause and what needs to be done to address it. A thorough physical examination that involves a variety of objective and subjective assessments of strength, flexibility, balance, and other variables is always the first and most important step of reaching an accurate diagnosis. But in some cases, additional testing may also be performed.

If your doctor is still uncertain of what is causing your pain or if a severe injury was sustained, she may recommend having a diagnostic imaging test to obtain more information. These non–invasive techniques let the doctor see inside your body to get a clearer picture of your bones, muscles, tendons, and ligaments. This can help to determine if any of these structures look damaged and are possibly contributing to your pain. Diagnostic imaging tests include x–rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans, which all use slightly different methods to produce images of the internal structures of the body.

• X–rays
• The most commonly used diagnostic test; readily available in many doctor’s offices
• Sends a type of electromagnetic radiation called X–rays through the body
• Bones and other dense matter appear white or light because they absorb the radiation, while less dense soft tissues (like ligaments and tendons) and bone fractures look darker because they let radiation pass–through
• X–rays do not show as much detail as more sophisticated tests but are often used as a starting point
• You are exposed to radiation which can, in some cases, cause harmful effects to cells of the body
• CT scan
• Combines X–rays with computer technology to produce a more detailed image that includes the size, shape, and position of structures deep in the body
• During the test, an X–ray tube will rotate slowly around you and take several pictures from all directions, which are displayed on a computer screen
• May be needed for problems with small, bony structures or severe trauma
• You are exposed to a much higher dose of radiation than with an x–ray, which in some cases, can cause harmful effects to cells of the body
• Costs more and takes more time than regular X–rays
• MRI
• Uses magnetic fields and computerized technology instead of radiation to take high–resolution pictures of bones and soft tissue
• Involves lying on a table that slides into the MRI scanner. MRIs employ powerful magnets which produce a strong magnetic field that forces protons in the body to align with that field. When a radiofrequency current is then pulsed through the patient, the protons are stimulated, and spin out of equilibrium, straining against the pull of the magnetic field; a computer records how these tissues respond to these radio pulses and then translates the data into a detailed picture
• May be used in helping to diagnose torn ligaments and cartilage, torn rotator cuffs, herniated disks, osteonecrosis, bone tumors, and other problems
• Other
• Ultrasound: is a radiation–free technique that uses high–frequency sound waves that echo off body structures to diagnose a variety of conditions
• Bone scan: shows bone activity throughout the body by injecting a small amount of radioactive material into a vein, which is absorbed by areas forming new bone (like fractures and bone tumors) and can be identified by a scan of the body several hours later

Each of these techniques can serve a unique and important role in the diagnosis of many conditions, but there are only certain situations in which they should be used. In our next newsletter, we’ll look into why diagnostic imaging tests are being overused and the downsides of this ongoing trend.