Part 1: Musculoskeletal Disorders & Common Back & Neck Issues

With the end of the year fast approaching, now is a great time to see a physical therapist it you’re trying to get the most out of your healthcare plan. We suggest you take a few minutes to review your health insurance policy and check on your benefit status as it pertains to your yearly maximums. If you’ve already met your deductible or out–of–pocket maximum for 2022, you will likely have a lower copay or no copay for the rest of the year before your deductible renews on January 1, 2023.

Seeing a physical therapist is perhaps the best decision you can make if you’re currently experiencing pain from any type of musculoskeletal disorder, as doing so is the safest, most effective, and least expensive route to less pain and greater function.

A musculoskeletal disorder is an injury or condition that involves the musculoskeletal system—which includes the bones, muscles, joints, ligaments, and tendons. These disorders are extremely common, with about 30% of Americans being currently affected. Musculoskeletal disorders can develop anywhere in the body, but the spine is by far the most common location, as low back pain and neck pain are among the leading causes of disability in the U.S. Other common musculoskeletal disorders include osteoarthritis, tendinitis, strains, sprains, fractures, and tears of ligaments and tendons.

Surgery vs nonsurgical treatment for musculoskeletal disorders

Patients with musculoskeletal disorders are faced with several potential options when determining how to address their condition, including surgery, which may be attractive to patients who believe it will lead to immediate relief. But the truth is that recovery from surgery requires effort, too, and the overall outcomes are often no better than those following nonsurgical interventions.

In a powerful study called a systematic review and meta–analysis, researchers reviewed the findings of 100 high–quality clinical trials on surgical versus nonsurgical interventions for various musculoskeletal conditions. These trials covered 28 different types of conditions at nine areas of the body, and in all studies that evaluated function, all studies that evaluated quality of life, and nearly all studies (9 of 13 [69.2%]) that evaluated pain, no clinically relevant differences were found between surgical and nonsurgical interventions.

These findings underscore why patients should strongly consider seeing a physical therapist before opting to undergo a surgical procedure. Surgery may have the appeal of being a “quick fix,” but it still requires extensive rehabilitation afterwards and is associated with several risks and extremely high costs. Physical therapy, on the other hand, is a cost–effective treatment option that is generally considered to be safe while providing similar outcomes to surgery in most cases.

To provide further context on the role of physical therapy for treating musculoskeletal conditions, we’re going to focus on the most common conditions in different regions of the body and provide evidence that shows how physical therapy can help.

Back and neck conditions most frequently seen by physical therapists

The spine is one of the most common locations in the body for musculoskeletal pain. Up to 50% of adults deal with neck pain each year, and up to 70% will encounter it at least once in their lifetime. The figures on back pain are even higher, as about 80% of Americans will experience an episode of low back pain at some point in their lives, making it the most common site for pain in the body. Many of the ailments that produce pain in the neck can also develop in the back, and vice versa. Here are some of the most prevalent conditions of the spine:

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can cause it to be damaged or torn; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, neck and back pains usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Both sprains and strains can occur either from a single incident or due to repetitive stress over time, and these injuries are responsible for most cases of neck and back pain, particularly in younger patients
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; a herniated disc is most likely to occur in the lower back, but they are also seen in the neck; common symptoms include arm or leg pain, numbness or tingling, and weakness
• Spinal stenosis: a condition in which the spinal canal—the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine—narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is most common in the lower back and the neck and is typically only seen in older adults since it’s caused by age–related changes
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of low back and neck pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; osteoarthritis can occur anywhere in the spine, and has been referred to as the most common cause of low back pain in people over the age of 50; patients typically experience pain and stiffness, as well as weakness or numbness in some cases

Evidence supporting physical therapy for neck and back pain

Physical therapists utilize a variety of interventions to address neck and back pain, including stretching and strengthening exercises, manual (hands–on) therapy techniques, pain–relieving modalities, functional training, education, and guidance on how to avoid further aggravation of pain. After adhering to these treatment recommendations, patients will eventually notice a marked reduction in their pain levels while gradually regaining the ability to move and function to levels similar to before the onset of their pain.

Research has shown that physical therapy can lead to a multitude of benefits for patients with back or neck pain, including less pain and disability, lower overall treatment costs, and a lower chance of needing additional treatments while avoiding both surgery and opioids. Other research has shown for patients with chronic neck pain, empowering patients with self–management strategies in addition to a comprehensive physical therapy program will lead to even greater overall benefits.

In our next post, we’ll look at the injuries and conditions involving the shoulder.