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Myth Busters III: If My Doc Can't Figure My Back Pain Out, I Must Be Really Bad Off!

Sara Shupe, MSPT, Dip. MDT is a physical therapist specialist and founder of J.O.Y. Physical Therapy Inc, a mobile, tele-health, chat and virtual physical therapy provider servicing the Twin Cities Metro Area, greater Minnesota, and Wisconsin. Sara has presented early access models of mechanical diagnosis and therapy (MDT) in the treatment of low back pain to the American Physical Therapy Association (APTA) of MN, National Association of Spine Society (NASS) in San Diego and Utah, and The international MDT Conference in Miami, FL. Sara lives in Eagan, MN with her family. 

If you have had low back pain for some time, studies say that the more times you see your practitioner for it, the more likely you will get scanning at some point, regardless of their necessity. Why would we receive a scan if it wasn’t “necessary?” Perhaps it has something to do the the lack of clarity in the European Guidelines for Management of Chronic Low Back Pain (CLBP), which states…

“We do not recommend radiographic imaging (plain radiography, CT or MRI), bone scanning, SPECT, discography, or facet nerve blocks for the diagnosis of non-specific CLBP unless a specific cause is strongly suspected.”

Can anyone see the conundrum? A “specific cause” for “non-specific low back pain” is the only time they would recommend it. As funny as that is (because I laughed out loud when I first read it!), if this was my guideline, I wouldn’t understand when to use a X-ray either. 

The Misdiagnosis.

Recent data has suggested that when a doc doesn't know what to do about back pain, they tend to misdiagnose it by relying on scans that are not designed to produce a reliable diagnosis. In chronic low back pain, which has cost this world in the billions of dollars (Hill et al, The Lancet 2011, reprinted 2017 The Global Press), this can lead to over-mediicalization.  What is “over-medicalization?” Well, I’m glad you asked! When you spend medical dollars on examinations and interventions that are not necessary. As in the case of chronic low back pain, not only does it waste medical dollars, but it also causes misdiagnoses.

Here are some of the issues listed by May and Rosedale in Physical Therapy: “poor criteria for present diagnostic labels, the questionable reliability of most orthopedic tests, and the questionable validity of commonly used orthopedic tests to identify the patho-anatomical structures they are meant to identify.” So how do we know where the problem comes from if these tests (i.e. Xrays) don’t tell us?

Avoid the fear of being misunderstood. Seek MDT.

Mechanical Diagnosis and Therapy (MDT) is one of the most studied methods in back pain evaluation, treatment and management. Due to its’ focus on patient-centered care, exercise prescription, and empowerment, it has become a leader in the rehabilitation world. I am privileged to be one of 450 Diplomats of MDT in the world and one of 5 in the great states of Minnesota and Wisconsin! 

Our published MDT Colleague, Dr. Mark Laslett has made some commentaries on why he continues to use and recommend it-

“It remains the only system that reliably and consistently works. McKenzie described it’s limitations and the characteristics of patients for whom it does not work too. Again I have no reason to change that either. My nearly 50 years of experience has not shown me a better alternative. 
I have tried and stopped using many ‘systems’, diagnostic and treatment techniques over 40 years, but McKenzie’s management of acute deformities has remained a solid constant in my practice.”

As a result of these trends in MDT and the successful treatment of back pain, Canada has implemented programs of savings by setting up physical therapists as the entry point of care for their low back pain, as well as other musculoskeletal problems (Woodhouse, S et al), saving the countries millions!

Like Canada, you don’t need a physician prescription to see a PT in MN or WI in most cases!  Get in today!

Save time and money with J.O.Y. Physical Therapy's mobile and telehealth specialized physical therapy as well as same-day visit options! Call 651-800-MYPT or go to www.joy-pt.com

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