Spine pain is one of the most common musculoskeletal ailments in the United States. A 2016 study indicated that neck and low back pain produced $134.5 billion in healthcare costs (https://www.healthdata.org/news-release/low-back-and-neck-pain-tops-us-health-spending). Part of that cost can be related to how medical providers explain pain and imaging findings to patients. Phrases like “Your back is trashed”, “this is the worst knee arthritis I have ever seen” or “you’ll never heal” can be especially harmful to a patient suffering from pain when the provider is trusted, or considered an “expert” in the field. According to the Cleveland Clinic, after age 40, most people have some amount of degeneration in their spine (1). There are many avenues of treatment aimed at managing degenerative changes and associated pain. Sometimes surgery and medication is the best option for spine pain, but oftentimes reduction in pain and improvement in function can be achieved with physical therapy.
The Role of Physical Therapists
Physical therapists are musculoskeletal experts with the expertise to help appropriate clients manage and heal their pain with conservative methods (i.e. without medication and surgery). A recent study showed that PT’s as a first-contact provider that ordered imaging were clinically appropriate in their order 90% of the time (as determined by a radiologist specializing in musculoskeletal imaging) (2). When physical therapists combine their in-depth knowledge of spine pain, a thorough evaluation and utilize imaging when necessary, it reduces healthcare costs, provides a more efficient plan for the patient, and improves communication of how the imaging results are pertinent to the patient’s specific deficits.
Common imaging findings as stated on radiology reports for spine pain include “severe interforminal stenosis”, or “significant disc bulge”, or “severe multilevel degenerative changes”. If these findings are not associated with any red flag or yellow flag clinical findings, like drop foot or progressive weakness, there is no need to use the phrases such as “your back is trashed”, which promote anxiety, fear, and maladaptive behaviors. Using such negative phrases can lead to a nocebo effect, the opposite of a placebo effect, where the patient experiences a more negative response due to negative expectations. A 2017 research study indicated that the “nocebo effect” can affect patient clinical outcomes and can reduce adherence to treatment (3).
Patients that are treated for spine pain often spend more time with a physical therapist than they do with any other healthcare provider on their team. PTs are in a unique position to develop trust, answer questions without being rushed, and provide guidance for various treatment options. When PTs use the combination of clinical examination, order and review imaging studies, and recognize that words matter when discussing relevant clinical findings, patients are likely to have better outcomes.
Learn More
Want to learn more about utilizing ordering and understanding musculoskeletal imaging? Join Redefine Health Education’s live, Zoom imaging courses held month. Take all 9 courses and earn your Master Musculoskeletal Imaging Certification.
Our 2 hour classes are held one time per month live via Zoom. Can’t make it to the live class? No problem, you can access all recorded classes in our on-demand video library.
Key points that will be covered through this certification:
- Understand how to order or recommend imaging studies, including best strategies to communicate with other healthcare professionals
- Determine how to analyze imaging results in sync with radiologists & other healthcare professionals, including both reports AND images
- Understand how to perform appropriate clinical correlation, & determine follow-up testing if applicable
- Understand how to communicate findings to patients in order to achieve the best possible clinical outcome.
Learn more and sign up here: https://www.redefinehealthed.com/product-page/master-msk-imaging-certification
References
Cleveland Clinic. 21, May 2021. Degenerative Disc Disease. www.my.clevelandclinic.org
Ordering of Diagnostic Imaging by Physical Therapists: A 5-Year Retrospective Practice Analysis. Aaron P Keil,Brian Baranyi,Sameer Mehta,Amma Maurer. Physical Therapy and Rehabilitation Journal. Volume 99, Issue 8, August 2019, Pages 1020–1026.
Nocebo effects can make you feel pain. Luana Colloca. Science. 2017 Oct 6; 358(6359): 44.