Why You Shouldn’t Quit Physical Therapy for Back Pain

If you stop working your physical therapy, your back pain could come roaring back. Trust the process and your providers.

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If you’re like a lot of people with their first episode of low back pain, you’re between the ages of 20 and 40 and you’re not sure what you did to cause such misery. You wonder if old running shoes are to blame. Or maybe it was that heavy box you carried. Or maybe your “gentle” yoga video isn’t so gentle.

Physical therapy is one of the best back pain treatments. Give it a chance to work. Physical therapy is one of the best back pain treatments. Give it a chance to work.

After weeks with this pain, you visit your doctor in hopes of clear answers and strong medicine. Instead, you get a diagnosis of “nonspecific back pain” and some benign tips, like “take a nonsteroidal anti-inflammatory drug” and “stay active but don’t overdo it.” When you restate how much pain you’re in, you finally get a prescription – but it’s for physical therapy.

If the scenario sounds like yours, congratulations. You don’t have something serious, and your doctor is wisely using a conservative approach.

Why Physical Therapy for Back Pain?

Nonspecific back pain refers to low back pain that isn’t tied to a clear cause, such as osteoporosis, inflammatory arthritis, or a tumor. It’s very common and often acute, meaning symptoms tend to resolve on their own within a month. Physical therapy (PT) can help the healing process along.

In fact, PT can improve a range of back-related problems, including those caused by disease or structural abnormalities. A 2015 study published in Annals of Internal Medicine found that PT works as well as surgery for lumbar spinal stenosis (a narrowing of the spinal canal in your lower back).

So, you see, you did get a prescription for strong medicine. It just doesn’t come in pill form – although, as with pills, you should still follow that prescription as directed.

Stick with the Program

A lot of people don’t follow through with their full course of physical therapy. Obvious reasons include time constraints, cost, and inconvenience. Other factors that contribute to non-compliance, according to a 2010 study in Manual Therapy, include:

  • Low levels of physical activity before treatment
  • Depression
  • Anxiety
  • Poor social support
  • Increased pain during exercise
  • Perceived barriers to exercise

The problem with stopping PT is that you could end up right where you started: in pain and at the doctor. Now you’re spending money on another healthcare visit, plus any imaging tests your doctor may order for you. That’s what the authors of the Manual Therapy study were getting at when they wrote, “Poor adherence to treatment can have negative effects on outcomes and healthcare cost.”

However, if you must stop PT, that doesn’t mean you’re destined for a lifetime of low back pain. You may not even lose the progress you’ve made.

“Whether or not you keep that progress depends on how much carry-through [you do] on your own. Sometimes when you stop PT, you stop doing everything [you’ve been working on] and backslide.

If you keep up with the program, then you would likely keep your progress,” says Theresa Marko, DPT, CEO of Marko Physical Therapy in New York City.

Dr. Marko notes that you may not see additional gains beyond the progress you’ve already made “since you don't have your physical therapist there to guide you to level up.”

Physical Therapy’s Science-backed Benefits

As an everyday person, you don’t measure the success of your back treatment the same way a researcher would. You want to take fewer pain relievers, reach the cookies on the high shelf in the pantry, request less time off work for healthcare visits. Some people might swear that unproven methods can help you achieve those goals.

Science requires more objective metrics to determine if a treatment works, and physical therapy consistently proves effective. In a recent review of multiple studies, researchers analyzed healthcare utilization and spending in patients with low back pain. The findings, published in PLOS ONE in 2016, were essentially this: Good physical therapy led to benefits everybody with back pain wants.

Specifically, patients who followed a physical therapy program that adhered to clinical guidelines had:  

  • Fewer PT visits
  • Shorter length of care
  • Fewer prescription medications
  • Fewer visits to the doctor
  • Less use of advanced imaging
  • Greater cost savings (between $300-$1300)

Other PT benefits, published elsewhere in the medical literature, are similarly compelling. For example, spine stabilization exercises during your first episode of low back pain can decrease pain, disability, and your risk of another episode, according to a 2012 review in American Family Physician.

A 2012 study in Spine highlights the value of early physical therapy for low back pain. When you get PT before the pain becomes chronic (lasting three months or more), you’ll likely have fewer doctor visits for back, less need for lumbar injections, and less need for back surgery. And if your acute pain does become chronic, meaning it lasts for three months or longer, PT remains key to feeling and moving better.

Choose the Right Physical Therapy Clinic

Americans shop around to find the “best” service or professional. That’s true whether you need a new internet provider, house painter, or pediatrician. It’s OK to be that picky about your physical therapist, too. Several studies have shown that a good relationship between patient and physical therapist can improve outcomes in low-back pain.

Dr. Marko says that when choosing a PT clinic, patients should be aware that there are different business models. The differences can directly influence your experience, so she shares some basics about a few of these models.

  1. Physical therapists treat more than one person at a time. Instead of chatting during the exercises, you’re more likely to do them solo after learning how they should be performed.
  2. Physical therapists see their patients once, then an assistant takes over. Assistants are competent at helping with exercise programs, but they don’t have the education or experience of a physical therapist.
  3. The clinic is either “out of network” or accepts no insurance at all. Patients pay more, but the benefit is more time and one-on-one care with a physical therapist.

If you don’t like your experience with one model, try another one, Dr. Marko suggests.

Just remember that you have an important role to play, too. You need to advocate for your own health, care, and progress.

“If the patient isn’t improving, the patient needs to have that discussion with the physical therapist,” Dr. Marko says. “The physical therapist can then problem solve and either try something new or refer the patient out” for additional care, such as imaging, medicines, or a different intervention.

Updated on: 02/25/21
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Theresa Marko, DPT
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