Do you have neck pain? Physical therapy can help.

Do you have neck pain?

A recent study found that getting physical therapy within 4 weeks of onset of neck pain leads to increased likelihood of reducing pain and disability (Horn et al., 2016). In rehabilitation literature, clinicians and researchers care about what’s called the Minimal Clinically Important Difference (MCID) for health outcomes. For example, if you tell me that you have neck pain of 10/10 — the worst pain possible — and then tell me that after 4 weeks your pain is 9.8/10, then that is not really a clinically important difference. Another way to talk about the MCID is to say that there is a meaningful change.

The authors of this study found that those who started physical therapy soon after the onset of neck pain were about twice as likely to have a meaningful change in both pain and disability. 

There is now a growing body of research showing that getting physical therapy early and often can reduce your pain and even lower your long-term healthcare costs. John Childs et al. (2015) found that getting physical therapy early for low back pain leads to 60% lower total costs related to low back pain.

If you are in pain, then you might be worried about the immense costs of getting an MRI, going from doctor to doctor, taking more medication, or getting injections. You may want to consider getting physical therapy first. The research supports it.

Should Physical Therapy Be Merely Physical?

What does physical therapy look like to you?

To you, physical therapy might be about stretching and exercise. Maybe it’s about cracking necks and backs. Maybe it’s about lifting heavy and lifting correctly. Maybe it’s even about ultrasound and TENS. Maybe it’s about slapping on a hot pack first, slapping on kinesiology tape next, and slapping on an ice pack last. Maybe it’s all of the above, as long as it’s physical.

To me, it’s none of the above.

Physical therapy is about improving the human condition. Our role as therapists is to engage in a partnership with people so that something about their movement or pain gets better. The exact technique we use to fulfill that role is open to debate, but there’s something about physical therapy we can’t debate: We treat people — whole people.

We don’t treat muscles, bones, or joints in isolation. Ever. We meet someone who presents everything about their health — their struggles, their passions, their dreams, their history, and their hope that the future will be less painful or easier than the present. Does that really sound physical?

As a profession, physical therapy shudders at the thought of managing psychological health. As many of my friends and fellow therapists have said, “We aren’t psychologists.” Of course we’re not. But if our goal is to optimize movement to improve the human experience, then we sign ourselves up for the task of addressing anything and everything that influences movement, so long as our methods are within our scope of practice. As I will discuss in later posts, the relationship between mental health and movement demands that physical therapy adapts to the psychological effects on pain and disability.

My goal as a student physical therapist is to take part, however small, in moving the profession forward. I want physical therapy to adopt the biopsychosocial model so vigorously that future therapists wonder what the profession was like when it lived within a purely biomedical framework. My goal, though, is not to appear as if I know all the answers; as a student, I am not even an entry-level physical therapist. What I do have, though, is a background in psychology. My bachelor’s degree is in psychology. I’ve had jobs at two psychiatric hospitals. I even spent six months in a Ph.D. program for clinical psychology before deciding that the fit wasn’t right.

To me, physical therapy is one of the most valuable ways to address the health of the whole person. The more I have learned about physical therapy, the more thrilled I am to see that some therapists value a background in psychology. Others are less thrilled. After finding out that my degree is in psychology, one PT said, “Oh, you’re one of those guys.”

Obviously, we have work to do as a profession. Our approach shouldn’t be afraid to look a little less physical and a little more psychological.

The obvious next question I hear from my peers, though, might be yours: “What does psychological treatment even look like?” I get it. I’ve asked that question, too, and I’ve been finding some answers as I continue to learn and to embrace my role as a student physical therapist. I encourage you to check out my post about a relatively new framework: “Psychologically Informed Physical Therapy Practice.”