Back Pain: Wait and See Does Not Save Money

America spends an estimated $90 billion per year on back pain, and back pain causes another $10-$20 billion in annual worker productivity losses. Given these extraordinary costs, managing low back pain better has become a national priority. To help save insurance dollars, some have strategized withholding physical therapy when people first visit a doctor. The theory is that waiting for back pain to go away on its own may be cheaper, and people can get physical therapy if it doesn’t go away on its own.

A big problem with that theory is that people who go to the doctor for back pain have already waited. The data regarding whether wait-and-see saves money in back pain has reached differing conclusions. To settle the debate, Majd Marrache and research colleagues conducted the largest study to date—including the medical records of 980,000 adults with orthopedic back pain.1 They found that people who received physical therapy within two weeks of the doctor’s visit cost the insurance companies $70 less in the first 30 days but $78 more over the course of the following year.

In other words, if you give physical therapy to everyone with back pain who wants it, when they want it, physical therapy will pay for itself. Researchers saw that without prompt referral to physical therapy, people ended up spending more money on ER visits, pain specialists, x-rays, MRIs, injections, etc. Withholding physical therapy for non-specific low back pain does not save money. It shifts spending to emergency departments, advanced imaging, specialists, and other healthcare spending. Immediate physical therapy has been found to improve quality of life for people with back pain, in a cost-effective way.2 Choose physical therapy.


  1. Marrache M, et al. Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database. BMC Health Services Research. 2022 Dec;22(1):1-9.
  2. Fritz JM, Kim M, Magel JS, Asche CV. Cost-Effectiveness of Primary Care Management With or Without Early Physical Therapy for Acute Low Back Pain: Economic Evaluation of a Randomized Clinical Trial. Spine. 2017 Mar 1;42(5):285-90.
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