02 Jan The Clinician’s Time Problem: Treating Back Pain When the System Won’t Let You
Article Rundown
- Why rushed assessments fail back pain patients
- The importance of the subjective exam
- When surgery is (and isn’t) the answer
- How a broken system keeps people stuck
Treating Back Pain When the System Won’t Let You
One of the most common questions I get from young clinicians is simple but loaded: How do you properly treat low back pain when the system won’t give you enough time? They see the value in thorough assessment models, but they’re stuck working inside a framework that prioritizes speed over understanding.
My answer is always the same—efficiency matters, but you cannot skip the parts that actually solve the problem. Back pain isn’t a drive-through diagnosis. When you rush the process, you don’t just miss details, you miss the mechanism.
The Subjective Exam Is the Foundation
Patients rarely walk in and give you the full story upfront. They forget injuries, minimize past trauma, or don’t realize what matters. Someone will tell you they’ve “never had an injury,” and ten minutes later you learn they fell hard in high school and their back has ached ever since. That one detail can completely change how you approach their case.
That’s why the subjective exam is non-negotiable. If I have two hours, the first hour is spent on the interview. Not because I enjoy talking, but because the clues live in the story—severity, irritability, triggers, history, and patterns that never make it onto an intake form. The better you get at asking the right questions, the more efficient you become without sacrificing quality.
Objective Findings Only Matter in Context
The objective exam should confirm what the story suggests. Range of motion, strength, and joint assessments matter, but they don’t mean much in isolation. What matters is how those findings line up with the patient’s symptoms and tolerance.
I assess the spine even when someone comes in for what looks like a peripheral issue. Calf pain, hip tightness, recurring strains—many of these cases have a neural or spinal driver. If you don’t assess upstream, you risk treating symptoms while missing the cause. The goal isn’t to collect data, it’s to narrow down what it is and what it isn’t.
Why So Many People Fall Through the Cracks
A lot of people end up in my office because they were rushed through someone else’s process. Fifteen-minute appointments, generic exercises, and a handoff to an aide create a disconnect between assessment and care. Patients leave confused, discouraged, or convinced they’re broken.
I’ve been on the other side of this myself. After tearing my bicep, I went through the standard physical therapy model and watched the machine at work. Measurements before questions. Checklists before context. No attempt to understand my baseline, my training history, or my goals. That isn’t assessment—it’s compliance.
When care is rushed, patients either quit rehab or get pushed toward interventions they don’t fully understand.
Advice for Young Clinicians Who Want to Be Great
If you actually want to help people long-term, my advice is simple but uncomfortable.
First, get out of the conveyor belt system as soon as you can responsibly do so. The best clinicians I know eventually build models that give them time and autonomy. You cannot do your best work when someone else dictates arbitrary limits that don’t serve the patient.
Second, specialize. Physical therapy is too broad to master everything. Pick a lane—lumbar spine, shoulder, hip, knee—and go deep. When you specialize, patterns become obvious, assessments become faster, and outcomes improve. That’s how you become efficient without becoming careless.
CBD: A Tool, Not a Solution
CBD came up in this conversation, and it’s worth clarifying. It’s not a miracle compound and it’s not what built my squat or “fixed” injuries. For me, it was a complementary tool that helped with sleep and reducing unwanted muscle tension.
Some people respond very strongly, others barely notice it. Quality and formulation matter, especially for anyone subject to drug testing. Used appropriately, it can support recovery, but it does not replace assessment, movement, or good decision-making.
If this is a tool you are interested in, check out our CBD store that checks all these boxes! Our products can be found on PowerRackStrengthCBD.com!
What I’ve Changed My Mind On
One thing I’ve softened on is how hard I push back when someone is determined to get surgery. I still educate. I still explain what surgery is likely to help—and what it won’t. But you can’t force someone’s decision.
If there are no red flags and symptoms are not severe or progressive, rushing into surgery is rarely wise. Even when surgery reduces leg pain, it often doesn’t resolve the back pain if habits and mechanics don’t change. All you can do is provide clarity and let the person choose.
What I’ve Doubled Down On
What I’ve doubled down on is this: the system is broken. Long-term outcomes are rarely tracked, success is poorly defined, and care is often driven by insurance rules instead of common sense. When even people inside the medical system avoid being treated by it, that tells you something.
This is heading toward more private, specialized, cash-pay models because both patients and clinicians are fed up. The solution isn’t more fear or more shortcuts—it’s better assessment, more specialization, and more time spent empowering people instead of dismissing them.
If you’re a clinician reading this, understand that you don’t have to accept the model as normal. Get sharper. Get specific. Learn to see patterns. Build a career where you can actually do the work the way it should be done.
Sorry, the comment form is closed at this time.