You want a happier back? Don't waste money on this 🤑

Today's newsletter might just save you thousands of dollars.

First, a Land Acknowledgment:

The Portland Metro area rests on traditional village sites of the Multnomah, Wasco, Cowlitz, Kathlamet, Clackamas, Bands of Chinook, Tualatin, Kalapuya, Molalla, and many other tribes who made their homes along the Columbia River. Indigenous people have created communities and summer encampments to harvest and enjoy the plentiful natural resources of the area for the last 11,000 years.

We want to recognize that Portland today is a community of many diverse Native peoples who continue to live and work here. We respectfully acknowledge and honor all Indigenous communities—past, present, future—and are grateful for their ongoing and vibrant presence. 

We also acknowledge the systemic policies of genocide, relocation, and assimilation that still impact many Indigenous/Native American families today. As settlers and guests on these lands, we respect the work of Indigenous leaders and families, and pledge to make ongoing efforts recognize their knowledge, creativity, and resilience. 

While you're reflecting on history and taking the day off, maybe also reflect on why your back hurts every time you bend over to tie your shoes.

October is National Physical Therapy Month, which sounds about as exciting as National Dental Hygiene Month until you realize physical therapy might save you from becoming a cautionary tale about the American healthcare system.

Here's the thing nobody tells you about back pain: the first provider you see determines whether you end up better or significantly worse off. Not "a little worse." We're talking thousands of dollars worse, with more procedures, more medications, and ironically, still dealing with back pain.

The Data Nobody Wants You To Know

Research tracking nearly a million people with acute low back pain found that seeing a physical therapist first dramatically lowered the chances of needing opioid prescriptions, advanced imaging, and emergency department visits compared to people who saw other providers first.

Another study compared people who got physical therapy within two weeks of their first doctor visit versus those who got advanced imaging first. The imaging group had higher odds of surgery, specialist visits, injections, and emergency visits. Their healthcare costs were nearly $5,000 higher over one year.

Five. Thousand. Dollars. For choosing the wrong first step.

That's a lot of money to spend finding out that yes, your 35-year-old spine looks like a 35-year-old spine on an MRI. Spoiler: most adults over 30 have "abnormalities" on imaging that have nothing to do with their actual pain.

Why Nobody Knows This

The problem isn't that imaging or specialists are bad—it's that most back pain doesn't need either one, at least not initially. Evidence-based guidelines consistently recommend exercise-based physical therapy as a first-line treatment for non-specific low back pain. Which is most back pain.

But here's where it gets interesting: most people don't know physical therapists can diagnose back pain. Research shows patients believe they need a doctor to diagnose their back pain first, then maybe try physical therapy if the doctor thinks it might help.

This is like insisting on seeing a mechanic to diagnose your check engine light before you're willing to check if the gas cap is loose. Sometimes the simple answer is the right answer, and skipping straight to it saves time, money, and unnecessary stress.

What Physical Therapy Actually Does

Modern physical therapy for back pain focuses on active treatment—exercise, movement training, and education about pain science. Studies show that higher amounts of active physical therapy were associated with decreased back and leg pain and better odds of clinically meaningful improvements compared to passive treatments.

It's not magic. It's identifying which movements hurt, why they hurt, and systematically fixing the underlying issue. Sometimes that's weak glutes. Sometimes it's poor hip mobility. Sometimes it's a movement pattern you've reinforced for years that's finally caught up with you, like how you've been picking up your toddler with your back instead of your legs since 2019.

The goal isn't just pain relief—it's teaching you how to manage your own back so this doesn't keep happening every time you sneeze or reach for something in the back seat. Research shows exercise therapy helps reduce anxiety, kinesophobia (fear of movement—yes, that's a real thing), and improves your ability to cope with pain. You become less fragile, not more dependent on treatments.

The Healthcare Cascade Nobody Warns You About

Here's how it typically goes:

Your back hurts. You wait a week hoping it'll go away. It doesn't. You see your doctor. They order an MRI because your insurance requires it before approving physical therapy (efficiency!). The MRI finds a bulging disc, which sounds terrifying until you learn that research shows most people over 30 have disc abnormalities whether they have pain or not.

Now you're worried. You see a specialist. They recommend injections, maybe surgery. You try the injection. It helps for three months. Now you're back where you started, except you're $5,000 poorer, you've had three procedures, and your back still hurts when you bend over.

Or you could have started with physical therapy, spent $600, learned how to move properly, strengthened the right muscles, and been done with it in six weeks. But hindsight is expensive.

October Special: Actually Try This First

Since it's National Physical Therapy Month and we'd prefer you not become another statistic in the "spent five grand to learn my glutes don't work" category:

Free exercise loop band to anyone who mentions this newsletter and becomes a new physical therapy patient

Exclusive gym member pricing:

• $299 for two visits

• $599 for five visits

This isn't a pitch for physical therapy because we make money on it. Our gym membership costs more than these packages. This is a pitch because the data is overwhelmingly clear that starting here instead of with imaging or specialists leads to better outcomes and significantly lower costs.

Your back pain probably doesn't need an MRI. It probably needs someone who understands movement to figure out what's actually wrong and how to fix it. And if it does turn out you need imaging or a specialist? Your physical therapist will tell you and send you in the right direction.

The Bottom Line

Early physical therapy means less healthcare utilization, lower costs, and better outcomes. Not sometimes. Consistently across multiple studies and hundreds of thousands of patients.

But you have to actually use it. And based on utilization rates, most people with back pain don't. They wait. They hope it goes away. They try home remedies from YouTube featuring suspiciously flexible people demonstrating stretches that would hospitalize most adults. Then when it's bad enough, they enter the healthcare cascade described above.

Don't be that person. Be the person who tried the thing that works first instead of the thing that's expensive and usually unnecessary.

Maybe start by popping into the Two Rivers office by the group fitness room and say hey. 👋

Keeping your bend and snap intentional,

Your West Coast Fitness Family

PS: You know what's even better than treating pain? Preventing it by learning proper form and having a professional spot you 😉 *ahem* personal training.