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Low Back Pain and the Role of the Physiatrist

Dr. Ana T. Acevedo

Low back pain remains the leading cause of work disability and the most costly musculoskeletal problem in the U.S. At Suburban Hospital Orthopedic Care, preventing and providing relief for back and spinal disorders is a key specialty. In this month’s column, Dr. Ana T. Acevedo, an experienced physiatrist with privileges at who recently joined Suburban Hospital, sheds some light on low back pain and conservative approaches to improving patients’ quality of life. 


How common is low back pain?


Low back pain (LBP) is the second-most frequent diagnosis in the United States, quickly surpassing the common cold. By age 20 about 50% of people have experienced low back pain. By age 60 the incidence is about 80%. Early diagnosis and treatment is the key to preventing recurrence. Untreated low back pain can cause lifestyle-altering changes in your posture, gait, and bearing that may worsen the problem or create a secondary problem.


What causes low back pain?


The most common causes are actually non-diagnoses such as "non-specific” low back pain or "degenerative diseases." More specific diagnoses include compression fractures, pinched nerves and myofascial pain, which is chronic aching pain in muscles that results from injuries and overuse. Another cause of LBP is spinal stenosis, which is a narrowing of the nerve openings around the spinal cord. Additional causes that need to be excluded in the diagnoses include malignancies, infections, congenital bone abnormalities, or connective tissue disorders such as lupus.


How do you treat low back pain?


It is important to first obtain the correct diagnosis. Multiple studies have shown that more than 90% of low back pain cases are treated non-surgically. Subsequently, a three-phase treatment plan is developed that may include the use of medications, injections, and referral to physical therapy for ultrasound, electrical stimulation and soft tissue mobilization. Once the acute pain is addressed, the next phase of treatment includes the development of flexibility, strength, and proper posture through therapeutic exercises. The last phase of treatment is the full restoration of function to a pre-injury level and the prevention of future injury.


Treatment plans should take into consideration the complete body, encompassing lifestyle issues and work status to provide the guidance to integrate the patient into a much more improved quality of life.

What is Physiatry?

Physiatry, officially called Physical Medicine and Rehabilitation (PMR), is a medical specialty focused on prevention, diagnosis and nonsurgical treatment of musculoskeletal disorders and acute and chronic pain management. The official name of this field of medicine reflects the two aspects of the specialty: “Physical Medicine” is the diagnosis and treatment of musculoskeletal disorders through special procedures, medications and exercise; “Rehabilitation” is the process of restoring the person to normal function through multiple techniques. Collaboration of multiple specialists such as physical therapists, occupational therapists and speech therapists is key in the process of rehabilitation.


What kind of training does a physiatrist have?


By the nature of their training and expertise, physiatrists are the ideal specialists to manage musculoskeletal disorders such as low back pain.

Physiatrist’s complete a bachelor’s degree and then proceed to four years of medical school, one year of internship and three years of residency in the PMR field in an accredited program. During the PMR residency program, physiatrists gain knowledge in the areas of internal medicine, orthopedics, neurology and rheumatology.  


When should you see a doctor for low back pain?


LBP is self limited. Most pain resolves in a 4-6 week period. However, early assessment is recommended to prevent secondary complications. Outcomes are usually better when problems are identified promptly. Procrastination or home remedies are not a substitute for a full examination by a well-trained physiatrist. Factors that are indications to see a physician include: low back pain that is associated with fever, unexplained weight loss, significant trauma, age (older than 50), failure to improve with over-the-counter medications, a history of cancer, diabetes, or a history of alcohol or drug abuse.


 What is the most important tool to assess patients with LBP?


The thorough personal history and physical examination remain the mainstays for evaluating LBP. Physiatrists may also use x-rays, laboratory tests, MRIs, or electrodiagnostic tests. Electrodiagnostic tests assess the electrical activity of nerves and muscles. This test is very helpful because it is the only real-time analysis that tells physiatrists what nerves may be involved.    


What doctor do I see first if I have LBP?


Physiatrists are well-equipped to be the primary caregivers for musculoskeletal disorders and provide a comprehensive approach to treat all aspects of the patient’s situation affected by LBP. It is also a cost-effective way of approaching the situation since MRIs and other diagnostic tests done unnecessarily may provide misinformation.


What is the bottom line with LBP?


Low back pain is a disability that is not always associated with a disease. Most people have some LBP during their lifetime and are more likely to have problems such as degenerative disc disease as they age.


It is the physiatrist's job to discover serious problems and provide guidance for treatment.

Often, there is little or no correlation between the anatomic abnormalities seen on MRIs and the patients’ clinical symptoms and signs. The model followed by physiatrists works to add years to life by improving the quality of life for people suffering from disability and musculoskeletal disorders.


About the Doctor

Dr. Ana T. Acevedo is a physiatrist with more than 18 years of experience. She is board certified and is a fellow of the American Academy of Physical Medicine and Rehabilitation. Dr. Acevedo's office is located at 11119 Rockville Pike suite 200. She can be reached at 301- 468-0006.


For more information about the Suburban Hospital Orthopedic Care, click here.

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