Sometimes, just the act of doing is enough to help us move forward. A new study shows how this can be true for lower back pain treatment with physical therapy.
A part of all doctor’s oaths within the medical field is to first do no harm. Our job, as doctors, is to look at the signs and symptoms that our patients present us with, figure out what testing/imaging/referrals needs to be done based on clinical information, and a physical exam all before any treatment is given. If no testing/imaging, or referrals, is needed to be done then it is laying out the best treatment plan for our patient. The treatment plans can, and often do, differentiate based on the type of doctor you are seeing. As a Naturopathic Doctor, our treatment plans will be focusing on the cause of the symptoms rather than just palliating the symptoms. That does not mean that there isn’t a time when we will palliate the symptoms as we are working towards finding the deeper condition.
Recently I ran across an article on NPR.org that was talking about the role of physical therapy in lower back pain. Often, we, as doctors, we will want to do more and more testing to make sure there is not something major going on. This costs the patient money, in some cases the insurance companies money, and we don’t always get more immediately useful information from the testing. However, getting patients started with safe and effective treatment sooner can help prevent bigger issues down the road. Physical therapy is one of these options. The NPR article talked about a study that had been done on people with lower back pain. This study compared how the people felt 3 months later with either early introduction of physical therapy, or no physical therapy (a “wait and watch” plan). Overall they concluded that there was no significant difference in the patients perceived/experienced pain.
It should be noted, and this is the take away from the study, that those who did the physical therapy showed signs of being able to perform daily tasks easier. Regardless of the lingering pain level of the patient.
In my experience, I would make the argument that most people want to be doing something about the pain/condition as quickly as they can. Some questions I answer quite often in a day can be how quickly will the prescribed treatment work, and how quickly will it make them feel better. So in the short term there might not have been any difference in the pain, but how the patient felt overall with the addition of physical therapy, or, for that matter, any non-harmful intervention such as chiropractic care was key. This is sometimes where the palliative care does come into its own.
Teaching a patient certain stretches/exercises that they can do to help alleviate their symptoms while the body heals can help the patient feel like they are doing something to help them get back to normal life. This, in so many words mind you, was what lead study author, Julia Fritz, PhD., had stated in the NPR article.
As with all things in medicine, the individual, their symptoms, and the specific case need to be evaluated to see what is going to be the best course of action. Medicine is not a one size fits all path. We, as doctors, need to do no harm to our patients, above all else, and help them using safe and effective means to heal as quickly as possible.
Image: Mariana Ruiz Villarreal (Wikipedia) (Public Domain by Author)