Low back pain (LBP) accounts for 2.5% to 3% of all physician visits in the United States.1-3 Annual direct health care costs were estimated at more than 85 billion dollars nationally in 2005, up 65% from 1997.4 The prevalence of chronic, disabling LBP is increasing, despite increasing spending on the problem.4, 5

Most patients with LBP initially access health care through their primary care provider.6, 7 Decisions in this setting are likely to have a substantial impact on outcomes and costs.8 Only 7% of people who consult their primary care provider for low back pain (LBP) are referred by their provider to physical therapy in the first 90 days of an episode.9 Practice guidelines generally recommend delaying referral to physical therapy for several weeks following initial consultation.10,11 The rationale for this recommendation is that most patients recover rapidly, and not intervening quickly wastes resources and might impede recovery for some patients by excessively “medicalizing” the condition.12,13

According to Fritz’s study in SPINE, early physical therapy intervention was associated with decreased risk of advanced imaging, fewer additional physician visits, fewer injections, and less opioid medications compared with delayed physical therapy. Early intervention was defined in this study as commencing within 14 days of initial onset. Total medical costs for LBP were $2736.23 lower for patients receiving early physical therapy.9 That is a cost savings of over $2700 per case, on average.

Dr. Gellhorn concluded in a separate study in SPINE that “There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties.”7 If the patient is not consuming more healthcare resources in this scenario it is likely because they do not require them. They got better.

Please call us if you need help directly, or for medical providers please email if you’d like a referral pad for your patients. We’re here to help people return to activity and get out of pain as quickly as possible. 415.593.2532, info@sfsspt.com

Addendum: The STarT Back screening tool is an effective way to simply and conveniently stratify risk and suggest the most medically appropriate clinical pathway for people with low back pain.14 We’ve even created an iOS app with the tool to make it even easier for you.   

  1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine 2006; 31:2724-7.
  2. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain: frequency, clinical evaluation, and treatment patterns from a national survey. Spine 1995; 20:1-9.
  3. Licciardone JC. The epidemiology and medical management of lowback pain during ambulatory medical visits in the United States. Osteopath Med Primary Care 2008; 2:11.
  4. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299:656-64.
  5. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169:251-8 .
  6. Deyo RA, Phillips WR. Low back pain: a primary care challenge. Spine 1996; 21:2826-32.
  7. Gellhorn AC, Chan L, Martin B, et al. Management patterns in acute low back pain: the role of physical therapy. Spine (Phila Pa 1976) 2012; 37:775-82.
  8. Feuerstein M, Hartzell M, Rogers HL, et al. Evidence-based practice for acute low back pain in primary care: Patient outcomes and cost of care. Pain 2006; 124:140-9.
  9. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs, 2012. Spine 2012; 25:2114-21.
  10. Koes BW, van Tulder MW, Lin CC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19:2075-94 .
  11. Murphy AY, van Teijlingen ER, Gobbi MO. Inconsistent grading of evidence across countries: a review of low back pain guidelines. J Manipulative Physiol Ther 2006; 29:576-81.
  12. Moffett J, McLean S. The role of physiotherapy in the management of non-specific back pain and neck pain. Rheumatology 2006; 45:371-8.
  13. Von Korff M, Moore JC. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001; 134:911-7.
  14. Hill JC, Dunn KM, Lewis M, et al. A Primary Care Back Pain Screening Tool: Identifying Patient Subgroups for Initial Treatment. Arthritis & Rheumatism 2008; 59,5:632– 41.