The Most Effective and Lowest Cost Option to Treat Low Back Pain

By MarieNelson on February 20th, 2020

Lowest Cost Treatment for Pain

Chances are, you or someone you know has had back pain. Over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.

The Alliance for Physical Therapy Quality and Innovation (APTQI) assessed different treatment interventions for low back pain within the Medicare program. What they found was the average total cost of care for low back pain (including doctor visits, testing, treatment, etc.) was $11,515 for those who received physical therapy as the first treatment compared to $13,606 for those receiving injections, and $24,294 for those receiving surgery.

Studies also show, the sooner you seek treatment, the lower your costs will be. Patients who were referred to physical therapy within 15 days of low back pain spent $3,500 less than those who received physical therapy within 45-90 days. Let’s take this thought process a step farther. Multiply that $3,500 saved with early physical therapy for each patient by the size of the sample used for the study, 472,000 beneficiaries. You get a savings of $1.652 billion dollars. That’s a whole lot of money that could be saved across the Medicare system just by trying physical therapy first. 

Moving on from costs, let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication – Low back pain is the #1 reason for opioid prescription in the United States, however in 2016, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging – Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common and a part of the aging process. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not.

Physical Therapy – Current clinical practice guidelines support manual therapy and exercise. Research proves that early physical therapy leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids.

Despite the data showing that physical therapy is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. Unfortunately only 2% of people with back pain start with physical therapy, and only 7% get to physical therapy within 90 days.

Surgery – The United States has sky high rates for back surgeries at 40% higher than any other country and 5 times higher than the United Kingdom. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible! A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had a 1 in 4 chance of a repeat surgery, a 1 in 3 chance of a major complication and 1 in 3 chance of never returning to work again. Ouch.

A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. From rotator cuff tears, degenerative disc disease and low back pain, to meniscal tears, knee pain and osteoarthritis studies have shown that physical therapy is as effective as surgery in treating a wide range of conditions. Don’t take our word for it though. These universities and doctors already did the homework for us.

  • The New England Journal of Medicine found physical therapy to be as effective as surgery for treating meniscal tears and knee osteoarthritis.
  • Thomas Jefferson University Hospital found that patients with degenerative disk disease responded as well to physical therapy as to surgery.
  • The Bone and Joint Journal found that physical therapy for rotator cuff tears produces results equal to those produced by arthroscopic surgery and open surgical repair.

So if physical therapy is as effective as surgery, why are so many surgeries still occurring? The most common reason for so many unneeded surgeries is that more conservative options aren’t tried first and perhaps, a lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than a placebo. Two such examples are kyphoplasty (a procedure for spinal compression fractures), and partial meniscectomy (a procedure used to treat tears of the meniscus in the knee). If a surgeon hasn’t continued to learn, they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them.

Every surgery, even “minor” ones, carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your physical therapist before a surgeon can help keep you out of the operating room and get you back to life without surgery.

Physical therapy for low back pain is available at our conveniently located facilities with a wide range of day and evening appointments available to suit your busy schedule. Call us today or request an appointment at