The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one-third of American adults and nearly 12 percent of children use alternative medicine – with back and neck pain being the top reasons for treatment.
Results of the 2007 survey of more than 32,000 Americans were released December 11 by the National Institutes of Health’s National Center for Complementary and Alternative Medicine.
According to APTA, physical therapy offers an evidence-based, time-tested solution to these common conditions in comparison to alternative treatments.
For neck pain, for example, a recent study published in the medical journal Spine found that when patients received up to six treatments of manual physical therapy and exercise, they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.
“This study, demonstrating the efficacy of physical therapy for a condition as widespread as neck pain, is particularly relevant in today’s challenging economic environment,” according to the study’s lead researcher and APTA spokesman Michael Walker, PT, DSc, OCS, CSCS, FAAOMPT. “The Kaiser Foundation, for instance, recently found that more than half of all Americans are not taking prescribed medication and postponing needed medical care in an effort to save money. It is important for consumers to know that there are effective, conservative solutions such as physical therapy available.”
Walker’s study compared the effectiveness of a three-week program of manual physical therapy and exercise to a minimal intervention treatment approach for patients with neck pain.
Study participants consisted of 94 patients with a primary complaint of neck pain, 58 (62%) of whom also had radiating arm pain. Patients randomized to the manual physical therapy and exercise group received joint and soft-tissue mobilizations and manipulations to restore motion and decrease pain, followed by a standard home exercise program of chin tucks, neck strengthening, and range-of-motion exercises. Patients in the minimal intervention group received treatment consistent with the current guidelines of advice, range-of-motion exercise, and any medication use prescribed by their general practitioner. Patients did not have to complete all six visits if their symptoms were fully resolved.
Sample exercises to relieve neck pain can be found on the APTA Web site, http://www.apta.org/consumer.
Results show that manual physical therapy and exercise was significantly more effective in reducing mechanical neck pain and disability and increasing patient-perceived improvements during short- and long-term follow-ups. These results are comparable with previous studies that found manual physical therapy and exercise provided greater treatment effectiveness (Hoving et al, 2002) and cost effectiveness (Kothals-de Bos et al, 2003) than general practitioner care.
1.Hoving et al. Manual Therapy, Physical Therapy, or Continued Care by the General Practitioner for Patients With Neck Pain. Ann Intern Med, 2002;136 DOI: (10):713-722
2.Bos et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial * Commentary: Bootstrapping simplifies appreciation of statistical inferences. BMJ, 2003; 326 (7395): 911 DOI: 10.1136/bmj.326.7395.911
A review of medical literature suggests that exercise, alone or in combination with education, may reduce the risk of low back pain, according to an article published online by JAMA Internal Medicine.
Daniel Steffens, Ph.D., of the University of Sydney, Australia, and coauthors identified 23 published reports (on 21 different randomized clinical trials including 30,850 participants) that met their inclusion criteria.
The authors report that moderate-quality evidence suggests exercise combined with education reduces the risk of an episode of low back pain and low- to very low-quality evidence suggests exercise alone may reduce the risk of both a low back pain episode and the use of sick leave. Other interventions, including education alone, back belts and shoe inserts do not appear to be associated with the prevention of low back pain.
“Although our review found evidence for both exercise alone (35 percent risk reduction for an LBP [low back pain] episode and 78 percent risk reduction for sick leave) and for exercise and education (45 percent risk reduction for an LBP episode) for the prevention of LBP up to one year, we also found the effect size reduced (exercise and education) or disappeared (exercise alone) in the longer term (> 1 year). This finding raises the important issue that, for exercise to remain protective against future LBP, it is likely that ongoing exercise is required,” the study concludes.
1.Mark J. Hancock, PhD et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, January 2016 DOI: 10.1001/jamainternmed.2015.7431
An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition–comparable to the total percentage of Americans living with a chronic lung or heart condition–costing an estimated $213 billion in annual treatment, care and lost wages, according to a new report issued today by the United States Bone and Joint Initiative (USBJI).
Musculoskeletal disorders–conditions and injuries affecting the bones, joints and muscles–can be painful and debilitating, affecting daily quality of life, activity and productivity. “The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action” outlines the prevalence and projected growth of musculoskeletal disorders in the U.S., and recommends strategies for improving patient outcomes while decreasing rising health and societal costs.
“This report provides the critical data needed to understand the magnitude of the problem, and the burden, of musculoskeletal disease in our country,” said David Pisetsky, MD, USBJI president, and professor of medicine and immunology at Duke University Medical School. “The number of visits to physicians for these disorders, the cost of treating them, and the indirect costs associated with pain and loss of mobility, are proportionately much higher than the resources currently being allocated to combat these conditions and injuries.”
“As a nation, we need to establish greater funding for musculoskeletal research, improve our understanding and strategies for prevention and treatment of these injuries and conditions, and ensure that more adults and children receive appropriate treatment sooner, and on an ongoing basis, to ensure quality of life and productivity,” said Stuart L. Weinstein, MD, co-chair of the report’s Steering Committee and a professor of orthopaedics and rehabilitation at the University of Iowa Hospitals and Clinics.
Prevalence and predictions
According to the report, the most prevalent musculoskeletal disorders are arthritis and related conditions; back and neck pain; injuries from falls, work, military service and sports; and osteoporosis, a loss of bone density increasing fracture risk, primarily in older women. An estimated 126.6 million Americans were living with a musculoskeletal disorder in 2012. More specifically:
•Arthritis is the most common cause of disability, with 51.8 million–half of U.S. adults age 65 and older–suffering from the disease.
•With the aging of the American population, the report projects arthritis prevalence to increase to 67 million people, or 25 percent of the adult population, by 2030.
•Arthritis is not just a disease for older Americans, with two-thirds of arthritis sufferers under age 65.
•Back and neck pain affects nearly one in three, or 75.7 million adults.
•Osteoporosis affects 10 million Americans, with 19 million more (mostly women) at risk for the disease.
•One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture, and 20 percent of hip fracture patients over age 50 will die within one year of their injury.
Cost and health care impact
The burden of musculoskeletal conditions is significant in terms of treatment and care, as well as the impact upon of quality of life, mobility, and productivity, and resulting in fewer days at work and in school. In 2011, the annual U.S. cost for treatment and lost wages related to musculoskeletal disorders was $213 billion, or 1.4 percent of the country’s gross domestic product (GDP). When adding the burden of other conditions affecting persons with musculoskeletal conditions such as diabetes, heart disease and obesity, the total indirect and direct costs rose to $874 billion, or 5.7 percent of the GDP in 2015.
Other data on the costs of musculoskeletal diseases and injuries include:
•Eighteen percent of all health care visits in 2010 were related to musculoskeletal conditions, including 52 million visits for low back pain, and 66 million for bone and joint injuries, including 14 million visits for childhood injuries.
•Arthritis and rheumatoid conditions resulted in an estimated 6.7 million annual hospitalizations.
•The average annual cost per person for treatment of a musculoskeletal condition is $7,800.
•The estimated annual cost for medical care to treat all forms of arthritis and joint pain was $580.9 billion, which represented a 131 percent increase (in 2011 dollars) over 2000.
•In 2012, 25.5 million people lost an average of 11.4 days of work due to back or neck pain, for a total of 290.8 million lost workdays in 2012 alone.
•Among children and adolescents, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.
Opportunities for action
The report provides recommendations to curb the tremendous economic and societal costs of musculoskeletal disorders, including:
•Accelerating research that compares treatment alternatives, develops new treatments and evaluates possible preventative approaches.
•Improving understanding of the role of behavior change in prevention and treatment, including weight loss and self-management of conditions once they arise.
•Ensuring that a higher percentage of the affected population receives access to evidence-based treatments.
•Implementing proven prevention strategies for sports injuries, workplace injuries, and injuries in the military.
•Ensuring that all children with chronic medical and musculoskeletal problems have access to care.
•Promoting better coordination between physicians and other health care providers treating musculoskeletal disorders: primary care physicians, specialists, physical therapists, etc.
•Ensuring that health care providers, especially primary care physicians, have the appropriate training to diagnose, and if necessary, refer patients for appropriate treatment.
•Addressing data limitations, and improve systems, to improve our understanding of these conditions and how best to screen, diagnose and treat them. This includes the impact of sex and gender on musculoskeletal disorders and responses to treatment, and tracking pediatric patients through adulthood to determine the lifelong burden of musculoskeletal disease.
“If we continue on our current trajectory, we are choosing to accept more prevalence and incidence of these disorders, spiraling costs, restricted access to needed services, and less success in alleviating pain and suffering — a high cost,” said Edward H. Yelin, PhD, co-chair of the report’s steering committee, and professor of medicine and health policy at the University of California, San Francisco. “The time to act to change this scenario to one with more evidence-based interventions and effective treatments, while simultaneously focusing on prevention, doing better by our society and economy, is now.”
American Academy of Orthopaedic Surgeons. “One in two Americans have a musculoskeletal condition: New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the U.S..”
Rice University catcher, John Clay Reeves, felt pain in his groin after a collision at the plate with an opposing player. He thought he had pulled a muscle, but it turns out he was suffering from a common condition seen in teens and young adults known as hip impingement.
“The issue with hip impingement is not treating it, but diagnosing it,” said Joshua Harris, M.D., a Houston Methodist orthopedic surgeon. “Ball and socket pain will be felt in the groin, which often leads to an initial diagnosis of a pulled groin. Some patients can spend six months to six years seeing three to five doctors before they finally get the correct diagnosis of hip impingement.”
Hip impingement occurs when either the socket or ball of the hip joint is not round, which prevents smooth movement within the joint. In most cases, this abnormal joint movement will lead to a tear of the hip labrum, a rim of cartilage that helps keeps the ball of the joint in the socket. Hip impingement can cause severe hip pain and, if not treated, might lead to the onset of arthritis in the patient’s 40s or 50s.
“We believe that most cases of hip impingement will begin in boys from 12 to 15 and girls from 11 to 13 who play high impact sports, such as soccer, track and basketball,” Harris said. “Between these ages, the bones are still growing and strengthening, so jumping too much can cause the socket and ball to hit repeatedly and will eventually cause one of them to lose their round shape.”
The good news is that the condition can be treated with arthroscopic surgery. An arthroscope, or small fiber optic camera is placed in the joint through a small incision at the hip. The surgeon will shave off bone as needed to make the socket and ball round again and will repair the labrum with sutures, which will relieve pain and improve function in 90 percent of cases.
While hip impingement is not yet preventable, Harris said it typically does not recur after arthroscopic surgery to treat it.
“More than 600,000 hip replacements are performed each year due to hip arthritis, with between 70 and 90 percent of hip arthritis cases stemming from untreated hip impingement,” Harris said. “We believe that treating hip impingement with arthroscopic surgery can delay or prevent the onset of hip arthritis, but studies to confirm that are still pending. Once it’s confirmed, we’ll have made significant headway in treating a large public health issue.”
Reeves has been catching since age 12 and has always experienced tightness in his hips. Since undergoing arthroscopic surgery, the tightness is gone and he’s ready to get back on the field.
“My hip would click and pop, which was painful, but then it would loosen up after stretching it out,” Reeves said. “I always thought it was normal, but I was able to tell a huge difference after having my right hip repaired last year. I’m now back to doing everything I was before with better flexibility and no pain.”
Houston Methodist. “Common hip issue in teens misdiagnosed as pulled muscle.” ScienceDaily. ScienceDaily, 24 February 2015. <www.sciencedaily.com/releases/2015/02/150224182524.htm>.