Low back pain: A physical therapist’s perspective

Low back pain: A physical therapist's perspective

Low back pain: A physical therapist’s perspective

When patients who are suffering from low back pain come to physical therapy for the first time, the two most frequently asked questions are, “Why was I referred to physical therapy when my MRI shows joint or disc abnormalities?” and “Don’t I need an MRI so you know what is going on?”

Both questions are very reasonable. After an MRI reveals a disc bulge or protrusion, many patients feel that a referral to a physical therapist is the equivalent of having your mechanic tell you to continue to drive your car and see if your flat tire improves. Frankly, both scenarios can feel ridiculous.

Thankfully, the human body is not like a car. Multiple studies in the last few years have shown that the farther a disc extrudes or protrudes, the more likely your body is to reabsorb the disc with time.(1,2) In other words, disc healing is a very real and normal occurrence.

MRI and X-ray Abnormalities

As we age, we can develop abnormalities that can be seen on MRI and X-ray. For example, in studies of patients without low back or neck complaints, about 30 percent of patients in their 20’s have disc bulging and degeneration.

The percent of abnormalities increases with age and by the time an individual is in his or her 80’s the prevalence of these abnormalities is greater than 80 percent.(3) Remember, these abnormalities are in patients without pain.

While there are times when surgery is needed to address low back pain, outcomes are significantly improved when abnormalities in imaging correspond with the expected complaints of the patient and positive clinical findings.

Watch the video below to learn more about how physical therapists can often treat lower back pain without surgery.

Low Back Pain Treatment

When developing a treatment plan for low back pain, it is important to realize that a one-size-fits-all approach is not appropriate. In other words, some movements and treatments that help one patient may not be effective for treating your low back pain.

Research has shown that subgrouping patients based on their history and clinical findings improves outcomes.(4) We do this first by getting a good history of the patient’s symptoms, screening for potential red flags, assessing neurologic involvement (how is his or her sensation and strength), and then determining movement or directional preference.

Movement preference is part of a spine examination where you complete range-of-motion exercises in particular planes of movement to determine how these motions affect your pain sensitivity or symptom location. Once movement preference has been determined, evidence-based therapeutic exercise and manual therapy are used to reduce pain sensitivity and restore previous mobility.

After the first visit to physical therapy, you should have a better understanding of what movements or postures are affecting your pain and what you can do immediately to improve symptoms. In each subsequent visit, response to treatment is reassessed and joint mobilizations, manipulation, soft tissue mobilization, and other various manual techniques along with progressive therapeutic exercises are utilized to further decrease pain sensitivity and movement limitation.

While the time it takes for symptoms to resolve varies, most patients should be able to see a benefit in their pain with physical therapy after the first few visits.


Nelson Caudill

Nelson Caudill is a physical therapist with KentuckyOne Health.

  1. Zhong M, Liu JT, Jiang H, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017;20(1):E45-E52.
  2. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-95.
  3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015;36:811–6
  4. Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290-302.

Know Your Nerves

Know Your Nerves

Know Your Nerves

Approximately 20 million Americans have some type of peripheral neuropathy, a condition that can often be prevented and managed.

Tingling, numbness, muscle weakness — when these symptoms occur in the foot, they’re often signs of one of more than 100 nerve disorders called neuropathy.

Damage to the peripheral nervous system typically begins in the nerves farthest from the brain and spinal cord. One of the most common causes of neuropathy is uncontrolled diabetes. Other factors that increase the risk for neuropathy include:

  • Alcohol abuse
  • Smoking cigarettes
  • Nutritional deficiency in B1, B12 or iron
  • Autoimmune diseases such as rheumatoid arthritis or lupus

Take Care

It’s possible to have neuropathy from diabetes without symptoms or with subtle signs that only a health care professional might notice. Numbness caused by neuropathy may make it difficult to notice cuts or swelling on the feet without routinely checking for them.

For this reason, doctors often tell patients with diabetes to do daily foot exams or, if they can’t, have a primary care provider or podiatrist do them. Unmanaged peripheral neuropathy can spread to the legs, arms and hands.

Nicole Everman, MD“Adopting healthier lifestyle habits, such as maintaining optimal weight, exercising daily and eating a balanced diet, can reduce effects of neuropathy,” said Nicole Everman, MD, neurologist with KentuckyOne Health Neurology Associates. “Physical and occupational therapy are also important when treating peripheral neuropathy because they help improve balance and motor strength.”

Other treatment options include oral medications for nerve pain and topical treatments such as capsaicin cream and lidocaine patches. An early diagnosis of neuropathy can help prevent further nerve damage, so people with symptoms should seek medical care.

Keep Your feet in Check

Most of us have heard the saying “an ounce of prevention is worth a pound of cure.” This is especially true when it comes to diabetic neuropathy.

“Studies have shown that those with diabetes can reduce the risk of experiencing nerve damage by keeping blood sugar levels close to normal,” said Dr. Everman. “Peripheral neuropathy can also be a result of vitamin A, vitamin E and vitamin B1 deficiencies, so eat more fruits, vegetables and whole grains.”

Other prevention methods include:

  • Wearing well-fitted shoes
  • Inspecting your feet daily for any redness, swelling or wounds
  • Visiting your primary care physician or a podiatrist regularly

This story originally appeared in the 2017 Fall edition of One Health Magazine. Sign up for your free subscription.

Not only do primary care doctors specialize in diagnosing and managing a wide range of health issues, they also teach you about prevention and wellness.  If you don’t have a primary care provider, find one near you today. To speak with someone about peripheral neuropathy, call KentuckyOne Health Neurology Associates at 859.263.8807.

Finding Hope, One Step At a Time

Finding Hope, One Step At a Time

Finding Hope, One Step At a Time
When Eden Hoelscher became paralyzed during a simple gymnastic move, her family traveled across the country to get her back on her feet.

On Dec. 23, 2015, Eden was a typical 5-year-old playing with her older sister, Isabella, when the unthinkable happened. Eden was performing a backbend — a gymnastic and dance move she had done hundreds of times — when she fell to the ground in agony. She was paralyzed from the waist down.

“We were in absolute disbelief,” said Kylee Hoelscher, Eden’s mother. “We lived in Los Angeles at the time, and every hospital we took Eden to gave us the same answer: She was going to be paralyzed the rest of her life.”

Crossing the Country for Care

Eden HoelscherUnwilling to give up, Kylee and Nicholas, Eden’s father, moved their family to Louisville to work with the team at Frazier Rehab Institute, part of KentuckyOne Health. The team quickly earned the trust of the Hoelscher family.

“They made treatment fun for Eden and encouraged her goofy personality to come through,” Kylee said. “Some physicians and physical therapists just do what they were taught in school. At Frazier Rehab Institute, they look outside the box.”

Little Miracles

Within 50 days, Eden was able to take her first steps with the support of a friend named Violet, who was visiting Eden from California.

Kylee recalls Eden predicting the progress she made with her friend’s support.

“Eden said, ‘Violet loves me so much,’” Kylee recalled. “‘I think when she gets here, her love will be so strong it will make me walk.’”

During a physical therapy session, Eden and Violet had an imaginary swordfight. While the physical therapist held Eden up, she began taking steps toward Violet and eventually made it all the way around the room and into the hallway. The family will always remember the day she took those first steps.

Nicholas, Eden, Isabella and Kylee Hoelscher

Nicholas, Eden, Isabella and Kylee Hoelscher

Grateful for the support and life-changing care Eden has received, the Hoelscher family are now firm supporters of Frazier Rehab Institute. They routinely raise funds for Jewish Hospital & St. Mary’s Foundation to support the facility that changed their daughter’s life, and invite the rest of the community to do the same.

“People come to Frazier Rehab Institute from all over the world. We want to give to a program that really makes a difference in the lives of children,” said Kylee.

This article originally appeared in the 2017 Spring edition of One Health magazine.

How to Become More Physically Fit [Video]

How to Become More Physically Fit

Are you making a new year’s resolution to become more physically fit? If so, KentuckyOne Health Sports Medicine specialist Jason Bracco has some tips to help you succeed.

The key is really about progressive loading so starting slow and gradually increasing the level of challenge. It usually takes about 21 days to build a habit. Then what you see is that they start to recognize the improved quality of life. They can do more. They feel better.

If you do suffer an injury don’t wait to seek care.

We have a sports medicine urgent care facility at Medical Center Jewish Northeast that’s open after hours and provides an evaluation and even a referral for physical therapy. We do a lot of the same things that we do with the athletes that we care for.