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Back pain

Early Physical Therapy Means Less Opioids

Early Physical Therapy Means Less Opioids

In a recent study published in the Journal of American Medical Association (JAMA) found that early use of physical therapy for lower back pain can correlate to a a 10-15% reduction in opioid use. Such a study highlights the power of exercise, manual therapy, and some of the evidenced-based modalities PTs can use, such as dry needling.

With such promising evidence, why aren’t patients seeking physical therapists (PTs) for many orthopedic and pain issues? First, many patients don’t realize that they have direct access to PTs. This means they can go straight to their PT and skip the medical doctors “Rx” or referral. Second, physicians often like to prescribe medications first before recommending other therapies; medical doctors are specialists in medicine and they receive little training and education in exercise and nutrition. Third, only about 10-20% of patients that are actually referred to PT choose to go! Perhaps these individuals have had bad experiences with PT or feel that PT was a waste of time in prior ailments. Such feelings can be understandable given the insurance industry has squeezed PTs into forming factory-like practices and limiting sessions/visits.

The amazing thing is that our practice offers you an actual solution. Having a cash-based, concierge practice, our team offers direct access with little to no restrictions. Our appointments can be fulfilled quickly and we can work on a variety of issues with various treatments without insurance squeezing our time or scrutinizing our methods. More importantly: the client pays for what they get! Providing our level of service, if patients don’t get better, then they don’t pay. How many insurance PT clinics offer this such guarantee?

The bottomline from this study is that if you have pain seek your PT and skip the pain killers.

Reference: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718095

Text Neck: Real or Fake?

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Do you check your phone often? Notice the burn in your neck or arm? Last year, I had a patient who had numbness down his left arm when he looked down at his phone or screen. Was this "text neck", the phenomenon of neck pain caused by frequent checking and texting from a mobile phone? Perhaps...it clearly was cervical radiculopathy, or a compressed/irritated nerve root in the neck. Fortunately my keen PT skills and few steroids later helped to get this patient back to work and pain-free neck movements. But it left me wondering -- did the phone lead to his issue?

A recent study done in Brazil puts into question whether "text neck" even exists. They took pictures of these kids as they looked at their phones, had experts analyze the pictures, and then cross-referenced the postures in the pictures with reported neck pain. This study did not show an association between text neck and neck pain in 18–21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.

Obviously more goes into neck pain than simply posture: exercise status, nutritional care, psyche, medications, and more. Check out the article, pay attention to your posture (maybe), and contact us to learn more!

https://link.springer.com/article/10.1007/s00586-017-5444-5

Low Back Pain: Exercise and the Mind

Lower back pain, even chronic lower back, responds positively to exercise, according to a recent large Cochrane review. For years we knew exercise, physical therapy (PT), and education could could help people recover from acute lower back pain. The effect on exercise on chronic lower back pain was questionable at best until this Cochrane review came out. Despite the positive news, many physical therapists still question what are the best exercises and what other factors are important to recovery.

A fantastic article published from a member of the Chartered Society Physiotherapy in the United Kingdom highlighted the importance of psychology with recovery of chronic lower back pain. The author sites:

Furthermore, he said that that negative language and beliefs about the body, such as describing it as ‘a broken machine’ or suffering from ‘wear and tear’, can affect the outcome of an intervention. 

It appears the beliefs and attitudes of a person can have a majority of impact on recovery from lower back pain. It is important to see the recovery from lower back pain as a team effort, with you, your PT, and often family helping you through recovery. Our expert staff have the skills to guide you through exercises and some psychologic tools to guide you through low back to full recovery. In rare cases we use a sports psychologist trained in cognitive behavioral therapy (CBT) to help even more. 

Call or mesaage us today for a consult in Naples, Bonita, or Marco Island.

Failed Back Surgery Syndrome (FBSS)

Chronic lower back pain is one of the leading causes of permanent disability. Often people with chronic low back pain will try multiple forms of treatment including Physical Therapy, medications, and injection therapy. Once they've exhausted all these efforts, many resort to surgery as the answer for their pain. Unfortunately only 35% of these cases are successful, particularly when Fusion is involved. As such, a group of pain management specialist recently have begun to use the diagnostic "label" of failed back surgery syndrome, or FBSS.

In the article below you can read how many pain specialists feel adding this additional "label" as a beneficial step. I would partially agree that the "label" is beneficial because some Physicians and surgeons are in denial that back surgery can fail. Some surgeons see patients with continued back pain after surgery as fakers or addicted to pain medicine. Physical therapists, as well as modern educated surgeons and Physicians, know that surgery is not always the answer for chronic lower back pain. Moreover, I strongly feel that simply adding a label is not enough.

As a physical therapist, I argue that simply adding a label may not be as beneficial as what occurs in the next steps after a patient is diagnosed or labeled. A large majority of patients with chronic lower back pain never seek psychological counseling. Emerging pain science Concepts are beginning to show that many of these patients with chronic lower back pain, as well as other forms of chronic pain, have larger issues at play. Many of these issues include anxiety, altered pain responses, depression, and chronic systemic inflammation from poor nutrition and lifestyle factors. Physical therapist are being armed with the knowledge of addressing some of these psychological Concepts through cognitive behavioral therapy (CBT) techniques, modern pain science techniques, as well as nutritional counseling.

Our team at Wells Physical Therapy embraces many of these Concepts and can help you or our friend through chronic pain. Contact us today for a consultation and enjoy the below article.

http://www.painmedicinenews.com/Primary-Care/Article/10-17/When-the-Last-Resort-Fails-Failed-Back-Surgery-Syndrome/44735