I remember the day vividly; it was the Sunday before Memorial Day Weekend 2019. Our family was working in the yard, and I allowed my boys to convince me that moving a 250-pound rock by hand was a good idea. At the time, I felt a little tweak in my neck, but thought nothing of it. The next day I noted some right-sided neck pain, no big deal. By Wednesday, I was experiencing unrelenting pain and numbness all the way down to my fingers. I tried everything I could think of, but couldn’t find anything that gave me much relief.
Did I mention that I am a licensed physical therapist with 28 years experience and two advanced certifications in the treatment of orthopedic conditions, more specifically the spine? Over the next three months, with a little patience and a lot of persistence, I was able to find relief and return to doing my daily activities.
It’s estimated by the World Health Organization that 60% to 70% of the population will experience low back pain in their lifetime. Neck pain appears to be a little lower at 30% to 50%. The chance that you, reading this column, has or will experience neck or back pain is fairly high. I have treated thousands of patients with similar conditions, but it wasn’t until I experienced it firsthand that I truly gained a whole new perspective and approach to my patients who are in this excruciating pain
There are a ton of options available with varying degrees of success or lack thereof. A quick Google search will recommend self-management with rest, over-the-counter medicines and activity modification. If symptoms continue after trying the basics, some people seek massage therapy, chiropractic care or a visit to their primary care physician. Oftentimes, the individual might be sent for X-rays, MRI, orthopedic, neurosurgery or pain management consultation. In the past, a prescription would have to be written by an MD, PA, NP, etc., in order to go see a physical therapist.
In Texas, we now have a limited version of direct access. This means you can go directly to a physical therapist to receive treatment. The clinic where you seek treatment should be able to answer the following questions: if they have therapist who can provide direct access service, how long you can be seen without a referral, and whether or not your insurance will pay for PT via direct access.
If you choose to seek physical therapy for your condition, do your research. Find an individual that can effectively evaluate, assess and treat your condition. Just like medical doctors, physical therapists can specialize in the area that they practice. Depending upon how an individual therapist was trained, the approach to treatment could be very different. For example, I am certified in the McKenzie Methods of Mechanical Diagnosis and Therapy. This certification process included 150 hours of additional education to become better at treating the spine.
The focus of this method is placed on patient empowerment, posture correction, body mechanics training, activity modification and instruction in specific exercises to elicit the desired outcome. There are definitely situations where hands-on intervention are needed, but about 80% of the people seeking intervention can effectively treat themselves once provided the proper information and home exercises. No matter the PT approach to your low back or neck pain, it should be determined within 1 to 2 weeks whether the therapist will be able to help you. Not all spine conditions can be managed with physical therapy, so if there has been no change in your condition, then you should be referred to your doctor for further evaluation and work-up.
The question sometimes arises, “Don’t I need an X-ray or MRI before having PT?” or “How can you treat me if you don’t know what is causing my pain?” These are legitimate questions, but the absence of significant trauma, these tests are typically not necessary to proceed with physical therapy intervention. A thorough evaluation will be performed, and as part of that evaluation we will look for “red flags.” “Red flags” are signs and symptoms that would indicate a possible spine issue that requires further medical work-up from a medical doctor before we proceed with PT evaluation and treatment.
Remember: Physical therapy is not a commodity. Not every therapist has the same qualifications to treat your specific condition. It is your right to choose where you receive medical and physical therapy services. Do your research and make an informed decision when choosing your health care providers.