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Posted on January 30, 2014

Complaints of low back pain are one of the most common reasons people visit doctors. Pain that has lasted only a few weeks is likely to subside on its own, making imaging tests such as X-rays, CT scans, and MRIs medically unnecessary unless the patient’s medical history or physical examine suggests otherwise. Yet patients sometimes requests such tests anyway, resulting in increased costs, unnecessary surgeries, and needless exposure to potentially harmful radiation.

Fewer than 1% of Imaging tests identify the cause of the problem. Imaging may also detect harmless abnormalities, causing patients to worry or undergo further testing unnecessarily. Even so, MRI scans of the lumbar region increased by more than 300% among United States Medicare beneficiaries from 1994 to 2006.

Strong evidence exitsm in multiple settings, that a system that places physical therpist as first providers for back pain has the potential to improve outcomes and reduce overutilization of finite and expensive resources, while providing both evidence-based and preference-sensitive healthcare (for exaple some patients will prefer to accept a smal risk to improve their function; others won’t).

An example of this is in Virgina Mason Medical Center in Seatle, WA where they changed the pathway for individuals presenting with low back pain. The proposed solution was to implement an evidence-base protocol with physical therapy up front.

The result was that within a year, the number of individuals with LBP who received an MRI decreased from 15% to 10%. In addition, the cost of an episode of care was reduced form $2,100-$2,200 to the $900-$1000 range. The earlier initiation of physical therapy also reduced the need for staff at the Virgina Mason’s chronic pain center, as fewer patient with LBP required that level of care


When used appropriately, diagnostic imaging is an important component of care for patients with low back pain. But, when used inappropriately, such imaging increases the risk of patient harm and contributes to rapidly rising healthcare costs.

Physical therapists play an important role in educating the patient consumer and should be considered earlier in the management of low back pain. This is important to consider as deductibles and co-pays rise.