Summary
Low back pain is a major public health problem. While there is no single therapy that can be prescribed to every patient with this problem, the ubiquitous prescribing of physical therapy is frequently misguided. The causes of low back pain are myriad, and the treatment algorithm needs to be tailored to the specific patient. All patients with back pain persistent for more than one month should be referred to a spine specialist in order to make further decisions regarding diagnosis and treatment.
Analysis
-While physical exercise is frequently prescribed for low back pain treatment, it is frequently a decision made in the absence of appropriate diagnosis and workup.
-In my opinion, the cost and time committment of physical therapy regimens needs to be taken into account when making this decision
-I believe that all patients with back pain should be evaluated by a spine specialist if the pain persists over one month, and certainly if the patient has had any imaging studies for evaluation of the back pain by the primary care physician. The spine specialist can then presicribe a treatment regimen, possibly including physical therapy.
-In other words, a spine specialist should be the gate keeper for physical therapy referrals, after appropriate workup and diagnosis has been performed. This approach would curb the unnecessary use of physical therapy in patients with back pain better managed with other therapies.
