Wait and See is Rarely the Best Approach: Exploring The Importance of Early Physical Therapy

Zachary Walston


When should you see someone for low back pain? This is a tricky question as it comes with the big “it depends” tag attached. Studies show that up to 90% of low back pain resolves on its own. On the surface, this number is encouraging, however, roughly three-quarters of patients will have recurrent low back pain within a year. Lastly, only 5% of people with acute low back pain will go on to develop chronic low back pain with disability. How do we determine who the 5% is and how do we make it 0%?

This is a tricky question that has stumped researchers and healthcare providers. There are many proposed answers to treating pain, some more beneficial than others. Treatment options for pain include but are not limited to physical therapy, chiropractic care, medication, surgery, and hope the pain goes away. In most cases, conservative care is the better option.

Our bodies are resilient and adaptive. Pain is highly variable as well.

What we do know is treating chronic pain — meaning pain lasting more than three months — is more difficult than treating acute pain. Decades of research show patients achieve better outcomes when they are treating in the acute stage (less than 6 weeks) compared to the chronic stage (more than 3 months). Does this mean all acute pain needs treatment? Not necessarily.

When Should You Seek Care For Low Back Pain?

If you recently helped a friend move, sat at a desk for 12 hours, or decided you were going to save some money and install a fence yourself, chances are you will develop low back pain. This is normal. If our body is overloaded, it often responds with pain or soreness to cue us to take it easy. The pain will resolve in a couple of days. Avoid bed rest and resume normal activities (wait on installing another fence for a week or so). These scenarios, of course, are not the only causes of low back pain.

If you find yourself routinely having episodes of low back pain, or you are experiencing it with a simple activity, then it would be beneficial to have a physical therapist take a look. Why a PT and not a physician? Allow me to explain.

Medication and Surgery Do Not Fix The Problem

Physical therapy involves a comprehensive assessment of all potential contributing factors to your low back pain, and it provides non-invasive treatments to build your body’s strength and resilience. Research clearly shows that low back pain cannot be determined through imaging, such as MRI. Not only do the MRI findings not explain low back pain — patients without pain have herniations and patients with pain have clean MRIs — they often lead to worse outcomes.

Opioids and other pain medication are simply band-aids with heavy side effects. Blocking the pain does not address potential factors leading to the pain. Lastly, surgical interventions have poor long-term outcomes, especially when the pain reaches a chronic state. Most low back pain can be successfully treated with physical therapy, which is both safe and cost-effective.

In general, activity and natural course will be superior to seeking external interventions. The heavy reliance on medication and surgery stems from a poor understanding of pain.

How To Best Address Pain

There is a common misconception about what pain is. Pain is not a simple indicator of damage in the body. Pain is complex. Psychosocial factors, including anxiety, depression, attitudes and beliefs, social context, or work status may all play an important role in the pain experience.

Pain has multiple potential causes, but the best way to ultimately address it is through a patient’s lifestyle. Exercise, adequate sleep, proper nutrition, and resuming daily activities can resolve and keep low back pain at bay. Acute pain is often the result of overloading your body. This can either be from too much activity or too little recovery.

A physical therapist can help you determine what the potential causes of pain were and design exercise programs to achieve your goals and long-term outcomes. While a full physical therapy plan of care is often not needed, receiving guidance can be helpful.

The other option people may seek is the wait-and-see approach. This can work if you have a regular exercise program, sleep and eat well, and resume your normal daily activity. The issue is when wait-and-see is coupled with inactivity, frequently focusing on the pain, and taking over-the-counter pain medication.

Bed rest and inactivity is not the answer for recovering from most causes of pain, especially low back pain. Inactivity can delay recovery. Our muscles weaken, our endurance declines, and we become more sensitive to painful movements. These changes often take longer to treat as well. Recovery is still attainable — you won’t need surgery — but the duration of care will increase.

When Should You Consult A Physical Therapist?

Going back to the original question — when someone should seek care — I would recommend at least consulting with a PT soon after the development of low back pain. This is one of the benefits of having a family PT, similar to have a primary care physician. You may only see the PT for a single treatment. But a session that provides reassurance that the issue is not serious along with few recommendations of activity tailored to your body and lifestyle is of far greater value than medication prescriptions. Seeking early care does not commit you to any treatment plan, but gives you answers and helps prevent potential costly, invasive care in the future.

As stated earlier, research clearly shows earlier intervention from PT is better than delayed or no PT. The results are better, and the cost is lower. Less time and effort are needed as fewer negative changes have occurred, such as loss of muscle and increased sensitivity to painful movements. Developing a partnership with a local PT can help you address potential concerns rapidly, rather than waiting until a problem becomes more serious. If the acute low back pain necessitates a full plan of care with multiple sessions, then your local PT will be there for you.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA

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