What can you do for a bulging disc anyway? This is a question that I am commonly faced when first meeting a patient with low back pain. The truth is, nothing. Physical therapy is not meant to reduce the bulge in a person’s disc or to correct the degeneration in someones spine nor does physical therapy reverse the presence of stenosis.
This answer typically leaves the patient dejected and questioning why they were referred to physical therapy instead of having a surgical consultation. Well, the truth is that for years research has shown that there is no relationship binding MRI findings to patients’ symptoms.
The majority of these articles state that with degeneration, disc herniation and stenosis that the primary factor in determining care is clinical presentation.
What does this mean for the consumer or patient who is visiting me for low back pain? Well, this means that physical therapy can help even after an MRI has shown structural changes. Most likely those structural changes are affecting the activation pattern of surrounding musculature which then results in abnormal movement which, over time, leads to pain. For example, go out into the yard and try to throw 100 pitches over the course of 2.5 hours like a baseball pitcher does. For most of us who are not pitchers, this is an abnormal movement. Yeah, we might play catch with the kids or the nephews or nieces on the weekends, but throw the ball 100 times? You would end up sore because your shoulder is not used to repetitive motions. The same goes for your back muscles if they are not used to the movement patterns due to structural changes, i.e. disc bulges or degeneration or stenosis.
It is our job as physical therapists to identify and address these abnormal movement patterns, decrease compensated muscle activation and return a patient to normal movement patterns so that the consumer can go on living life with minimal to no pain.
But why pay for physical therapy if the doctor might still order an MRI? Good question. The answer to that resides in an article recently published in Health Services Research Journal by Fritz and colleagues stating that upon reviewing the care of 841 people, those who were first referred for MRIs spent (or their insurance companies spent) on average $4,793 more than those who were first sent to physical therapy for conservative care.
In conclusion, regardless of what your MRI results say or if you are trying to determine whether or not to have an MRI, understand that physical therapy can be effective in reducing your back pain and aiding you in getting back your previous lifestyle. Not only that, but physical therapy can also be financially friendly to your checking account. Think about it, who would not want to feel better AND have more money left over?
Joel DeMaris, PT, DPT, CMTPT
Isanti Physical Therapy
PTC_therapy April 1st, 2015
Posted In: General