Last Sunday, I saw an acquaintance hobbling painfully, bent forward with low back pain. After discussion of her symptoms and history, I suspected that her pain was discogenic, meaning that one of the discs between the vertebrae was causing her symptoms. After telling her this, she told me that she had a “problem with her discs” before, and that she really needed to see her physician before she could come see me.
STOP RIGHT THERE.
“Why?” I asked.
“Well, I just need to see if there’s a problem with my disc,” she answered.
WHAT?
“Well, he might think I need an MRI,” she continued.
WHAT?
I have never seen an MRI cure someone’s low back pain.
Orthopaedic physical therapists can diagnose and treat mechanical low back pain of all sorts, including back pain from disc problems. Clinical exam for herniated discs have been shown to have 0.85 sensitivity, meaning that if my clinical tests do not show a disc problem it is unlikely that the person’s pain is related to a herniated disc or other disc problem. One particular test, the crossed straight leg raise, has very high sensitivity (over .90), meaning that by performing one hands-on test, I can determine with a high degree of certainty whether there is a disc problem.
Conversely, MRIs of low backs are neither sensitive nor specific for pinpointing the structure generating symptoms. In fact, even in asymptomatic individuals, 40-60% of people will have some degree of “disc bulge” on MRI.
In the state of Georgia, physical therapists can evaluate without consultation, and can treat patients “in consultation with a practitioner of the healing arts.”
You do not need a referral to be evaluated by a physical therapist. While your insurance may require a physician’s referral, the law does not.
There is a misconception in all of healthcare that somehow expensive diagnostics equals better care. This is not true, and it’s an expensive and damaging misconception.
Back pain that is hours or days old is much easier to treat than pain that has gone on for weeks or months or years while you wait for the test results or the insurance approval or the physician’s referral.
You don’t have to wait to feel better.
