October is National Physical Therapy Month. I started off the month by spending a couple of days at the California Physical Therapy Association Conference. I spent most of my time at a course called "Expert Musculoskeletal Care, PTs' Role in U.S. Healthcare." Here are some pearls of wisdom that I picked up:
*People with LBP are 3 times as likely to have surgery if referred for an MRI instead of an Xray but there was no difference between the groups in function or satisfaction one year later. JAMA 2003.
*A study of people without any pain who were over 60 years old found that 21% had spinal stenosis, 36% had herniated discs, and 90% had degenerative or bulging discs.
*Approximately 50% of normal male subjects over 60 years old and 35% of female subjects over 60 had meniscus tears. New England Journal of Medicine 2008
*“For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits- for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehab, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy.” Annals of Internal Medicine 2007.
* Cognitive intervention and exercise are likely more effective for disability than spinal fusion surgery. Pain 2006.
*For patients who have low back pain with an onset of less than 16 days and no pain below the knee, 91% do very well with five sessions of Physical Therapy; the first two for spinal manipulation and three sessions of therapeutic exercise. BMC Family Practice 2005:
*A small study showed that 10/10 patients with low back pain were better able to contract the deep, stabilizing muscle, the transverse abdomninus, immediately after spinal manipulation. JOSPT
*Long-term outcomes (8 -10 years) for surgical management of spinal stenosis was no better than non-surgical management. Spine 2005
*Manual Therapy and assisted walking on a treadmill (using a harness to partially support body weight) was more effective than flexion-based exercises and level treadmill walking for patients with spinal stenosis. Spine 2006.
*Manual therapy can help 75% of patients with chronic headaches (for 5-7 years) feel at least 50% better. 1/3 will be 100% better. Spine 2002
*Manual therapy plus exercise results in significantly better outcomes for patients with osteoarthritis of the hip than exercise alone. 81% are successful with the combination of manual therapy plus exercise compared to 50% of those who received exercise only. Arthritis and Rheumatism 2004
*Patients with osteoarthritis of the knee were less likely to take pain medications and were more satisfied with their outcome if they received 8 sessions of physical therapy with manual treatment plus exercise than if they only had 2 sessions for instruction in a home exercise program.
The overall take-home message is that while exercise, including yoga, is often enough to provide some therapeutic benefits for those with musculoskeletal problems, manual therapy is often a crucial component of achieving the best results possible. This is true for everyone from the young guy who’s back just ‘went out’ to the elderly lady with significant arthritis of her spine or hip. So if you or a client has had a recent flare up of pain or a joint problem that just won’t go away, head to your nearest PT clinic that offers hands-on, manual therapy.
See the APTA website to Find a PT in your area.
Opening image from Manual Orthopedic Physical Therapy, Inc. Perhaps a good choice if you live in the San Diego area.
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