Having a basis for determining which patients will benefit from referral to physical therapy is important. By watching for three significant signs in examination, you can determine if early referral to therapy will be effective. Research has shown that non-specific acute LBP can no longer be considered a homogenous category. Numerous studies support classification and sub-grouping of patients who benefit from different therapy treatment.

Mechanical low back pain (MLBP) should be identifiable once red flags have been ruled out through history and examination. Too often MLBP is treated with medication and encouragement alone leading to relapse rates over 60 % within the same year.

Three strong indicators for P.T. referral

1. The presence of a lateral shift.  A lateral shift cannot be reliably detected by visualizing alone so sideglide in standing should be checked.  In his 2006 book Rapidly Reversible Low Back Pain Ron Donelson, MD points out that studies of MLBP show that a directional preference can be found in over 75% of acute patients. In studies of acute low back pain, treatment with either medications alone or with specific exercise, patients were followed for one to three years. At one year, recurrence in the medication group was 84% with 30% for exercise. At three years the rate was 75% in the med group and 35% with exercise. 
2. Loss of lumbar extension. Increased posterior intervertebral disc loading occurs during flexion. Extension of the lumbar spine is essential to restore normal intradiscal pressure. Loss of extension ROM over time through sustained or repeated forward bending may even predate the patient noticing pain.
3. Variability in the location of pain after movement or position change. The typical MLBP patient may report pain in more proximal or distal locations depending on movement or body positioning. Pain history may reveal a progression to more distal pain over time.

When your patients are seen at First Choice Rehabilitation our therapists provide immediate education and home instructions which have been found to be important long term success. Relief of pain, eliminating reoccurrence and promoting self-care are the goals of our program. Early referral to therapy can be the means to seeing the best results with your back pain patients today.