Balanced Physical Therapy

Balanced PT distributed this article to area physicians on 3/15/08

A randomized controlled trial published recently in Spine demonstrated that intervention including manipulation, an individualized exercise program, and guided exercises produced faster and more cost effective results than “normal medical care” in cases of acute and sub-acute simple low back pain (LBP).¹  The study demonstrated that the subset of simple LBP patients who are off work often do not return to work for months.  

The trial compared 111 cases of simple LBP, primarily acute or sub-acute.  Group 1 received what Wright et al defined as “the normal route of care as directed by the general practitioner” plus advice and The Back Book.  Group 2 received the same access to general practitioners, education, and literature as Group 1 plus joint and soft tissue mobilization, steroid injection (as indicated by physician assessment), a specific home exercise program, and six sessions of guided exercises over two weeks.  Participants in the guided exercise group spent 35% less time off work (an average of 7 days) and showed significantly better results on pain assessments and health status assessments at one month and two months.  Even though patients in Group 2 received injections and physical therapy and returned to work better prepared for the rigors of their jobs, participants in Group 2 reduced overall costs by $367 to $850 per patient.  The financial costs to both the individual and employer were totaled.  This cost saving result directly contradicts the out-dated belief that it is more cost-efficient to withhold restorative treatments until the LBP has existed for 90 days. 

Since researchers could not reliably measure compliance in Group 1, patients in Group 2 who missed appointments were NOT excluded from the data pool.  Furthermore, Wright et al did not exclude participants who sought healthcare outside of that provided by the study.  Patients not prescribed physical therapy were five times more likely to use the services of a chiropractor or acupuncturist.  In general, individuals in Group 1 proved four times more likely to seek non-study intervention than those in Group 2. 

Wright et al did not perform a follow-up after two months, but noted that Pengel et al quoted an acute LBP recurrence risk of 26% within 3 months and 66 to 84% within 12 months.²  An individually designed exercise plan and guided exercises, such as those available at Balaned Physical Therapy, may be considered a reasonable part of any LBP strategy when part of the goal is to reduce the typically high rates of reutilization.  Indeed, multiple studies have demonstrated how physical therapy approaches can prevent future LBP episodes and minimize reutilization.^3-8

With their scientifically based, proactive LBP protocol, you will find Balanced Physical Therapy to be efficient and cost-effective (especially in the long-term) for most of your cases of acute, sub-acute, and chronic low back pain.  In cases of work injuries, you will also find that Balanced Physical Therapy returns your patients to work quickly and better prepared for the job’s physical demands.

Certified Strength & Conditioning Specialists

The NCSA awards the CSCS certification to professionals who possess the knowledge and skills to design and implement safe and effective strength & conditioning programs.  Therapists with this well-respected certification serve as part of the expert team at Balanced.  Just one of the many reasons you can trust Balanced Physical Therapy with your patients.

Please Put Balanced Physical Therapy On Your Team

REFERENCES

1. Wright A, Lloyd-Davies A, Williams S, et al. Individual active treatment combined with group exercise for acute and subacute low back pain. Spine 2005; 30(11): 1235-1241.
2. Pengel LHM, Herbert RD, Maher CG, et al.  Acute low back pain: systematic review of its prognosis. BMJ 2003; 327: 323-5.
3. Gundewall, B., M. Liljeqvist, and T. Hansson. Primary prevention of back symptoms and absence from work: a prospective randomized study among hospital employees. Spine 18: 587-594, 1993.
4. Mooney, V., M Kron, P. Rummerfield, and B. Holmes. The effect of workplace based strengthening on low back injury rates: as case study in the strip mining industry. J. Occup. Rehab. 5: 157-167, 1995.
5. Nelson, B., E. O’Reilly, et al. The Clinical Effects of Intensive, Specific Exercise on Chronic Low Back Pain: A Controlled Study of 895 Consecutive Patients with 1-Year Follow-Up. Orthopedics. October 1995; 18 (10): 971-981.
6. Legget, S., Mooney, V. Matheson, L.N., Nelson, B. Dreisinger, T., Van Zytveld, J., Vie, L. (1999). Restorative exercise for clinical low back pain. A prospective two-center study with 1-year follow-up. Spine 24 (9): 889-898.
7. Lonn, J.H., Glomsrod, B., Soukup, M.G., Bo, K., Larsen, S. Active back school: Prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study. Spine (1999) 24 (9): 865-871.
8. Cady, l., D Bischoff, E. O’Connell, P. Thomas, and J. Allen. Strength and Fitness and subsequent back injuries in firefighters. J. Occup. Med. 21: 269-272, 1979.   

©BMA 2008