Low Back Surgery – 3 Thoughts You MUST Consider Beforehand

Low back surgery - Back pain

Low back surgery should never be the first consideration for low back pain.  Realize that low back pain was a $100 billion problem back in 2006, with 2/3 of that being lost wages and lack of productivity. Previously, medications were recommended, but we have found out lately that this is ineffective.  The amount of money being spent on back pain has likely increased since then.  Low back pain can be quite painful, but in a large number of cases, this pain will resolve within a 6-12 week period. This back pain can be so debilitating and it will affect your ability to function in society, and some want to think that low back surgery will be the cure. So the debate has been raised for years about what are the best interventions to address for someone experiencing such a condition. The blog will discuss the most recently published and current recommendations by the American College of Physicians (ACP), along with our thoughts on each recommendation. You can click HERE to review the guidelines and then continue reading below.

Low back surgery - Back pain

What Do The Guidelines Recommend?

Firstly, they discuss back pain as being acute (less than 4 weeks), subacute (4-12 weeks) or chronic (greater than 12 weeks), with the greatest number of cases being acute or subacute. Now let’s look at the ACP recommendations.

Recommendation 1

They recommend that since most people will fall under the acute or subacute timeframes, then non-pharmacological interventions are the best to consider initially. The ACP states that regardless of the intervention, most people will have a resolution of their back pain. These recommended interventions include superficial heat, massage, acupuncture and spinal manipulation .

Thoughts on Recommendation 1

The ACP intervention recommendations of superficial heat, massage, and acupuncture are thought to work on managing the pain element. This is important for initial recovery. Spinal manipulation can actually serve to do both at the same time. Manipulation increases joint mobility and can alleviate pain signals from reaching your brain. So by reducing this pain, you are now able to move more freely, with less pain. Remember that “motion is lotion” and means that movement is important to maintain and perform. Seeing a low back physical therapy expert will help you get on that road to recovery quickly so that you can remain mobile and independent without the use of medication.

Click On This Link To Receive More Information About Easing Your Back Pain.

Recommendation 2

For clients with chronic low back pain, the best interventions are as follows: exercise, using a multidisciplinary rehab team, mindfulness-based stress reduction, tai chai, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, and spinal manipulation.

Thoughts on Recommendation 2

This is a lot of potential intervention!! So many options, which is why we believe a lot of people are confused . If you Google “low back pain treatment,” you will see the same laundry list of possible interventions, including low back surgery. So we often get asked by our clients, “What works?” To be honest with you, all of these items can work, so long as they address the underlying cause for YOUR pain. We believe having a multidisciplinary rehab team is important, with the client at the center, and great communication amongst themselves about the client. This allows the pain and movement elements to be collaboratively addressed, again, in the best interest of the client. As you can also see, that spinal manipulation is again recommended even for chronic back pain.

Recommendation 3

The ACP recommends that if non-pharmacological therapy is found to be ineffective, then pharmacological intervention may be warranted. The first recommendation is the use of non-steroidal anti-inflammatory (NSAID) medication before considering opioids. These should only be considered if NSAIDs have not helped.

Thoughts on Recommendation 3

As doctors of physical therapy, we do not prescribe medications. Although, a large number of clients we work with will be prescribed these as part of their intervention plan. We work closely with physicians and communicate our findings and your progress. We can then make recommendations together to help our clients make sound decisions. It is our belief that opioids can help with pain, but will likely not address the underlying cause for the pain. So having an overseeing physician organization making a recommendation of this is encouraging. We find that when clients use the medication in isolation, the outcomes are generally poor. So seeing a low back physical therapy expert will help you get on that road to recovery so that you can remain mobile and independent to wean away from the need to continue using any medication.

Click On This Link To Receive More Information About Easing Your Back Pain.


So the recommendation are the use of superficial heat, massage, exercise, acupuncture, and spinal manipulation for people with low back pain. In most cases, this low back pain will resolve regardless of the treatment you chose. Did you see that low back surgery isn’t even on the list of recommendations? Remember, that a low back physical therapy expert will be able to determine the cause of your pain and develop an intervention plan. This plan may include collaborative intervention with other professionals, like physicians, massage therapists and acupuncturists. Surgery may be an end option, but should be the last consideration.  And really consider your effort because back surgery requires recovery and hard work on your part.  Exercise is very important to consider to keep moving… which means that yoga, tai chi, pilates and personal training can have an important part of your recovery. Lastly, we recommend early intervention because waiting will likely increase your length of recovery. We find that faster results happen when people react accordingly to get the right help.

Dedicated to you health,

Dr. Chris Ingstad

Chris Ingstad, PT, DPT, OCS, MTC, ATC, FAAOMPT

Performance Physical Therapist at Level4 Physio-Wellness-Performance
Dr. Chris Ingstad is a nationally-known Physical Therapist and Co-Founder of Level4 Physio-Wellness-Performance, San Diego’s Leading Specialist Private Physical Therapy and Human Performance Practice for People in their 40’s, 50’s and beyond, who value their health and want to remain active.

You might know Dr. Chris as a National Conference presenter on various rehabilitation topics, including on treating people with shoulder, neck and low back injuries. He also teaches at the University of St. Augustine for Health Sciences in the Musculoskeletal track, where he brings clinical practice into the classroom for future physical therapists. He also is published in Jiu Jitsu Magazine and Coastal Newspaper on various areas, including low back and neck and shoulder injuries.

Dr. Chris’ background included working extensively with athletes with shoulder, knee and low back injuries, taking them from post-injury or post-operative to return to sport. He prides himself on the ability to get positive outcomes, even with difficult cases. Level4 Physio-Wellness-Performance is now a large multi-physical therapist specialty practice in Encinitas, CA. In his free time, he enjoys cycling, golfing, hiking/camping, and training Brazilian Jiu Jitsu.
Chris Ingstad, PT, DPT, OCS, MTC, ATC, FAAOMPT

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