Surgery vs. Physical Therapy for Low Back Pain: What's the better option?

One of the most common complaints of patients that attend physical therapy is persistent low back pain. Low back pain is the most prevalent of all musculoskeletal conditions, affecting up to 80% of Americans at some point in their life. Low back pain is attributed to almost 150 million days of work lost per year. From the years 1997-2005, the cost of treating low back pain has risen 65% to $86 billion/year. This is comparable to the cost of cancer treatment in 2007, at about $89 billion/year.



Common treatments for low back pain include various forms of surgery including, but not limited to; fusions, discectomies, and laminectomies as well as steroid injections, and opioid painkillers. Although these treatments are common, it does not always mean they’re effective:


  • Spinal fusion for low back pain has been found to have no advantage over non-surgical treatments (i.e. physical therapy)

  • Steroid injections for sciatica provided moderate changes in symptoms, but there was no change in the source of the injury

  • Opioids have been found to offer little to no significant reduction in pain when compared to non-opioid or placebo treatments


A recent review of articles regarding surgery for lumbar spinal stenosis found no conclusive evidence to recommend surgery over nonsurgical treatment.The review did mention that 10-24% of surgeries had side effects, but nonsurgical treatment (i.e. physical therapy) had no side effects.


In 2012, a study looked at the cost effectiveness of early physical therapy intervention versus delayed physical therapy intervention. The study found that those who engaged in early physical therapy had a decreased need for MRI’s and X-rays, extra doctor visits, surgery, injections, or medication. Patients who sought out early physical therapy, on average, spent $2736 less on overall treatment than those who had delayed physical therapy.


While around 80% of the American population will experience low back pain at some point in their life, low back pain is unique to everyone who experiences it. Low back pain can manifest in different ways and can also be treated in different ways. We suggest that if you are experiencing low back pain that you seek out physical therapy treatment to get you on the right path to reducing your pain and restoring your function!






Written by Maya Acocella


References:


Freburger JK et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3): 251–258.


$86 Billion Spent on Back, Neck Pain. WebMD. https://www.webmd.com/back-pain/news/20080212/86-billion-spent-on-back-neck-pain. Accessed November 2, 2021.


Chronic Back Pain. Health Policy Institute. https://hpi.georgetown.edu/backpain/. Accessed November 2, 2021.



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