Where You Start Is Where You End

Where you start is where you end.

Where you start is where you end. I was recently at a continuing education course and this quote from the instructor stuck with me. We were discussing research related to prognosis with early PT intervention vs PT intervention after seeking medical intervention first. This concept is something that our profession has been shouting from the rooftops.

Musculoskeletal pain is our jam. Your PT is trained to be able to identify areas of your body that need some consideration by assessing your movement patterns, your symptoms, and your medical history. We then form hypotheses based on what you tell us and what we see/feel. From there we work on lowering your pain threshold through interventions like manual therapy, loading (strengthening) to further lower pain threshold, and education regarding pain neuroscience, modifications, and techniques to reduce inflammation. A trip to a pharmacological provider for musculoskeletal pain (low back pain for example) may include imaging (pricey and potentially unnecessary exposure), prescriptions, and recommendations for therapy or rest.

What does the evidence say? A study published in Health Services Research reviewed 150,000 insurance claims and found that those who saw a physical therapist as their first point of care vs a pharmacological provider demonstrated the following1:

1. 89% lower probability of receiving an opioid prescription
2. 28% reduction in advanced imaging, such as MRI
3. 15% lower probability of an ER visit
4. 19% higher probability of hospitalization

Whoa, number 4 is scary right? Not really. Your PT is educated and trained in systems review, screening, and diagnostic considerations that warrant a referral outside of the clinic which likely accounted for a majority.

More evidence to support a PT-first approach is an article through JAMA Network Open that found only a 10% reduction in opioid prescription if patients started physical therapy after seeing a pharmacological provider first2. Any reduction in opioid prescription is great, but the case is clear when comparing a 10% reduction with an 89% reduction with a PT-First approach.

Physical therapy is a fantastic option for musculoskeletal pain. We’re fun, like to hang out, and you won’t need to make a trip to the pharmacy after your session. We will refer you to other providers if our conservative approach is not an appropriate option for you.

Bottom line- seek out conservative care first for your musculoskeletal pain. Where you start is where you likely end up. Where do you want to be?

1. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs Bianca K. Frogner, Kenneth Harwood, C. Holly A. Andrilla, Malaika Schwartz, Jesse M. PinesHealth Serv Res. 2018 Dec; 53(6): 4629–4646. Published online 2018 May 23. doi: 10.1111/1475-6773.12984PMCID: PMC6232429
2. Sun E, Moshfegh J, Rishel CA, Cook CE, Goode AP, George SZ. Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain. JAMA Netw Open. 2018;1(8):e185909. doi:https://doi.org/10.1001/jamanetworkopen.2018.5909