Recent research published in February 2020 found that a physical therapy evaluation (your first appointment) for low back pain can have a significant impact on symptoms.  The greatest effect was observed following the history taking or subjective portion of the initial visit.  So, this isn’t new news for us PTs.  I think we all know the power active listening has on our patients, especially those with low back pain.  Most commonly when I have a new patient with low back pain (and I think the next statement also applies to those with fibromyalgia and neck pain) they tell their story of how they have been to x many doctors and specialists and no one has asked them as many questions as I have about their pain and their life.  I think this is where physical therapists set themselves apart.  Now, we have some research that demonstrates taking a thorough history can impact a patient’s pain levels on day one and maybe just as important, if not more than strength and range of motion assessments.  

Something else to think about is people who suffer from low back pain will likely already be categorized as “chronic” by the time they get to us and that means they also have a higher correlation for depression and anxiety related to their pain 1,2.  Our best tool in this case may be our ability to take a thorough history, to truly listen to their concerns and their fears and their expectations.  As a telehealth physical therapy and rehabilitation provider, this research helps to support what many of us have been forced to do since the start of Covid-19, virtual sessions. Many clinicians as well as patients may be hesitant to try digital or virtual physical therapy for fear of not providing or finding the relief patients want, but now we can confidently say the power of listening can have a significant impact on pain levels and symptoms.        

FInal thought: What I hope we can take from this bit of research is that active listening has the potential to be more effective than sending them home with exercises on day 1.  That we cannot understate the value of taking a thorough history and truly understanding where our patients are coming from and what they expect. That the healing can start with just our open minds and our ears.     

References:

1. Aline Ramond, Céline Bouton, Isabelle Richard, Yves Roquelaure, Christophe Baufreton, Erick Legrand, Jean-François Huez, Psychosocial risk factors for chronic low back pain in primary care—a systematic review, Family Practice, Volume 28, Issue 1, February 2011, Pages 12–21, https://doi.org/10.1093/fampra/cmq072

2. Fernandez, Matt, et al. Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study. The Spine Journal, Volume 17, Issue 7, February 2017, Pages 905-912. 

Article: Evaluation is treatment for low back pain. J Man Manip Ther. 2020 Feb 24;1-10.