Updated: May 31
Can you really trust a Physical Therapist with your spine?
If you are not leery of every aspect of our healthcare system, you should be. So questioning if it is really safe to see a Physical Therapist without even seeing a “real” doctor is one that I understand. The simplified answer is yes, you can, the rationale is not so simple though. Most people are going to base this decision on their past experience with various providers and stories they may have heard from friends and family. The brutally honest truth is that spine care or really any care really has been turned into a HUGE business. But competition is a good thing, right? Not in all cases.
The reality is that you should question every answer you receive from any provider. Do I think PTs are more qualified to treat spine pain patients? Absolutely, not. Unfortunately, with the time I have spent in a standard healthcare model I have come to realize that there is not a single profession that has all the answers. That being said, there is plenty that has the absolute wrong answers but that is not why I am writing this. I am writing this because you as a consumer of information should not be led to think that there is only one path to feeling better.
Research, as reported in The Journal of Orthopaedic & Sports Physical Therapy in 2018, found that there was no significant difference between patients who saw an MD then went to PT versus those who went directly to PT through direct access models. This is significant today because there is too much wasted time and finances occurring when seeking help for spine care. Your typical path to relief is flawed and dangerous at times.
You’re out doing yard work or playing with the kids and feel a twinge, but it doesn’t last so you don’t think much about it. You go in and rest on the couch, sit and eat dinner, then it’s off to bed. You wake up and feel like someone is jamming a burning sharp dagger into your back and let’s not talk about the pain shooting down the leg! The logical thing to do in this situation is to rest right? I mean isn’t that the first part of RICE?! Well, this is a pretty bad idea but who wants to move when it hurts so bad? This is where being educated on what pain actually means and what your body is trying to tell you is important.
A few days later you are still hurting so you take a day off work to see the MD. You are given pain meds and muscle relaxers and often told to rest more. Well, these band-aids are not fixing anything, so you end up back to the doc. Well, if that combo didn’t work let’s try a steroid, an x-ray or MRI, and a referral to a specialist.
You have the MRI which is miserable and EXPENSIVE if you have a high deductible plan, or no insurance and the best part is that the specialist says you have “age-appropriate findings” or even better “the spine of an 80-year-old” (at 30-40). Either way, the next step is a neurogenic medication and stronger pain meds. If they found something on the imaging (which they likely will since evidence has found that out of 100 non-symptomatic people off the stretch 80% had at least one bulging disc), you may even get scheduled for an injection at this phase. This is where PT MIGHT get introduced but the problem is that most PTs are ill-equipped to treat spine patients. If you are lucky you will end up with someone that has done a lot of post-grad education specifically for the spine.
Unfortunately starting PT here has the risk of results getting confused with the injection. Some people will go to PT before their injection and will be educated and helped to the point that they no longer need the injection. Others will get the injection and stop PT because the injection “fixed” their back. The first group will hopefully escape the healthcare system with a solid set of tools to help them control their pain and adjust their body mechanics. The latter group tends to be repeat injection customers. Eventually, they stop working as well and now you are really in for some fun. Surgery should always be used as the LAST option, do NOT let anyone operate on your SPINE until you have exhausted all other options! There is a reason it is called your CENTRAL nervous system.
Now to the point of this post, if the outcomes are the same regardless of starting with PT or at the doctor, why is one way better than the other? Well, each step mentioned above is another expense. Whether it’s your co-pay, medication cost, injections, imaging, etc. they all cost you time and money. So, time and money are the short answer. The other interesting finding from this same study was that a PT that utilizes evidence-based screening can accurately determine the appropriateness of Physical Therapy as a treatment for your issues. This helps ease the concerns over safety some professions note as a reason to not pass direct access. So, we have safety, effectiveness, and efficiency noted as reasons you can trust a PT with your spine IF you ask questions to determine that they are well versed in spine care.