Updated: May 10, 2022
We recently started a monthly clinical review meeting here at The Green Room PT, including review of the latest research and manual techniques on a different topic each month, and having each therapist share what they found so that our practice can stay up-to-date with the latest research and clinical practice recommendations. This past month, the topic was Lower back pain. Below, I will summarize some of the key findings from all of our research:
1. Based on a study or 753,450 eligible patients with a primary care visit for Lower Back Pain between 18-60 years of age, it was found that PT was utilized by only 16.3%, and of those, only 24% received care in the first 2 weeks after injury or pain onset. These patients were divided into 4 groups: early referral to PT with adherence to the treatment plan, late referral to PT with adherence to the treatment plan, early referral to PT without adherence, late referral without adherence. Of all 4 groups, early referral (within 2 weeks) to Physical Therapy with adherence to the treatment plan for those with lower back pain was associated with significantly lower utilization of opioids, injections, and surgery, and significant reduction in the cost to the patient in overall medical costs.
a. Ref: Childs, Fritz, Wu, et. Al., 2015. Implications of Early and Guideline Adherent Physical Therapy for low back pain on utilization and costs. BMC Health Services Research.
2. Based on a meta-analysis (gold standard for research) comparing different treatment approaches to chronic lower back pain, it was found that posterior chain resistance exercises were superior (think lower back, glutes, hamstrings, hips, etc.) for reduction of pain and disability, whereas a walking and general exercise program was good, but not as effective. Furthermore, it was found that the best results were found under a supervised program that lasted about 16 weeks. We found this interesting, because many MD scripts to PT are for 6-8 weeks, but the best results according to the highest level of research is found after 16 weeks of consistent supervised therapy.
a. Ref: 2021. Posterior chain resistance training compared to general exercise and walking programmes for the treatment of chronic low back pain in the general population: a systematic review and meta-analysis.
3. Did you know that you can use squats, deadlifts, bench, and rows to treat lower back pain, when they are done correctly?? This is based on a Feasibility study on patients with non-specific lower back pain (LBP). Patients did not have any structural changes nor did they have any radiculopathy at the start of treatment with average pain levels of <4/10. The study used 10 rep max (RM) training used throughout 16 weeks of treatment with a 4-week acclimating period. Specific, consistent instructions used for each patient for deadlifts, bench press, squat, and pendlay row. Perceived benefits were improved pain, daily functioning, energy level and sleep, and changes in views on physical activity.
a. Ref: 2020. Tjosvall, et. Al. Periodized resistance training for persistent non-specific low back pain: a mixed methods feasibility study.
4. Constipation can contribute to lower back pain! A study showed that constipation displayed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain, whole body. If you have an issue with constipation and also have lower back pain with/without sciatica, there may be a link! Treat one to help treat the other!
a. Ref: 2018. Young-Chang, et al. The Association Between Constipation or Stool Consistency and Pain Severity in Patients With Chronic Pain
So, that’s a wrap! I tried to summarize it in a way that wasn’t overly technical, but these studies are always quite specific and full of medical jargon. So, if you have any questions about this blog article, feel free to leave a comment or e-mail us at firstname.lastname@example.org
In good health,
Dr. Ashley Bertorelli, Physical Therapist and Clinic Owner, The Green Room PT
Clifton Park & Troy