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2019 Literature Review part 1: neck, back, and jaw pain

We distribute news each week to help educate you—our patients—on some of the most common injuries and conditions that we treat, and to explain why we always recommend seeing a physical therapist early when dealing with any type of pain. In working towards this goal, we also regularly summarize research studies that show how physical therapy typically leads to the best possible outcomes, and how it helps patients avoid surgery and other costly or unnecessary treatments in the process.

With the end of the year approaching, we’d like to look back at some of our favorite study summaries of 2019 in a four—part newsletter series, with each one focusing on a different topic or region of the body. In part 1, we review research on physical therapy for neck pain, back pain, and issues with the jaw called temporomandibular disorders.

Neck pain

Of all conditions that cause disability, neck pain ranks fourth. It’s estimated that about 30% of adults experience neck pain each year, and up to 70% will deal with it at least once in their lifetime. A number of conditions can cause neck pain—including strains and sprains, osteoarthritis, spinal stenosis, a and herniated disc—but the end result is usually a limited ability to function normally.

Timing of physical therapy consultation on 1—year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort (2018)

  • Background: physical therapist—led interventions like hands—on (manual) therapy and stretching and strengthening exercises are commonly recommended for neck pain, and research suggests that the timing of when a patient starts treatment will affect their costs and use of other healthcare services
  • How the study was conducted: 308 patients with neck pain who underwent physical therapy were placed into one of three groups based on when they first consulted with the therapist; these groups were early consultation (started treatment within 14 days), delayed consultation (within 15—90 days), or late consultation (within 91—364 days)
  • What the results showed: patients who consulted with a physical therapist early saved about $2,172 compared to the late physical therapy group and $1,063 compared to the delayed physical therapy group; the early physical therapy group also showed a lower risk for being prescribed opioids and having injections or imaging tests compared to the late treatment group
  • Take—home message: the timing of physical therapy makes a difference, and patients with neck pain are urged to start sooner rather than later in order to reap the greatest benefits at the lowest costs

Back pain

Back pain—especially low back pain (LBP)—is even more common than neck pain. LBP actually ranks as the most common painful condition and the number one cause of disability in the U.S. Recent statistics have shown that about 25% of the population has been affected by LBP for at least one full day within the past three months, about 80% of people will experience it at some point. While most cases of LBP will improve after some time, some patients are affected by persistent—or chronic—pain that lasts for several months or longer.

Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs (2018)

  • Background: although physical therapy is recommended for patients with LBP, not all patients start treatment right away, and this delay may affect what other healthcare services (like tests and other treatments) they end up using
  • How the study was conducted: the medical records of 46,914 LBP patients were divided into five groups depending on whether they received physical therapy and when treatment started; these groups were 1) no physical therapy, 2) immediate physical therapy (treatment started within three days), 3) early physical therapy (4—14 days), 4) delayed physical therapy (15—28 days), 5) late physical therapy (29—90 days); the amount of healthcare these patients used and the associated costs were then compared between groups
  • What the results showed: the longer patients waited to begin physical therapy, the more healthcare services they used and the higher the costs of their treatment; seeing a physical therapist immediately or early was associated with the lowest costs and healthcare usage
  • Take—home message: patients with LBP are encouraged to see a physical therapist sooner rather than later, as doing so will likely lead to better outcomes and lower costs

Comprehensive Nonsurgical Treatment Versus Self—directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial (2018)

  • Background: lumbar spinal stenosis (LSS) is a common condition in which the space that surrounds the spinal cord narrows, which can cause pain and weakness in the lower back, buttocks and thighs; most patients with LSS are treated with conservative care like physical therapy, but more research is needed on its effectiveness
  • How the study was conducted: 99 patients with LSS were randomly assigned to undergo either a conservative treatment that included exercise, education, and manual (hands—on) therapy, or self—care, which did not include any specific interventions; patients’ walking ability, pain, and function was assessed for up to 12 months
  • What the results showed: patients who completed the conservative treatment program experienced significantly greater improvements than the self—care group in walking ability, pain, and function that lasted into the long term
  • Take—home message: since conservative treatment that includes physical therapy was beneficial, patients who have LSS should strongly consider seeing a physical therapist to reduce their pain levels and improve their functional abilities

Temporomandibular disorders

The temporomandibular joint connects the part of the skull directly in front of the ears (temporal bone) to the lower jaw (mandible). It allows you to move your jaw up and down and from one side to the other, which is necessary for talking and chewing. Temporomandibular disorder—or TMD—is a general term used to describe a variety of conditions that cause pain and dysfunction of this joint, which can lead to problems moving the jaw.

The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta—analysis (2017)

Background: physical therapy and exercise—based interventions (exercise therapy) are frequently used for TMDs, but the research is mixed as to how effective exercise therapy is for these disorders

How the study was conducted: a systematic review and meta—analysis was performed, which collects and analyzes research on the same topic; six high—quality studies called randomized—controlled trials were included, all of which compared exercise to other treatments or placebo for patients with TMDs

What the results showed: patients who underwent exercise therapy experienced moderate short—term benefits of reduced pain and improved flexibility compared to other treatments; a mixed approach to exercise therapy may be associated with the best outcomes

Take—home message: exercise therapy appears to be effective for TMDs, and patients with these conditions should therefore see a physical therapist to begin this type of treatment program

In our next news message, we review our top summaries on studies that cover shoulder pain, wrist pain, and hand pain.

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