Musculoskeletal pain — injuries and conditions affecting muscles, bones and joints — accounts for nearly 10 percent of all emergency room visits in the United States each year, or about nine million patients treated and discharged annually.
As hospitals look for ways to better manage pain and reduce reliance on opioids, some emergency departments are placing physical therapists directly inside ERs. At the University of Missouri Hospital, that approach is showing promising results.
At MU Health Care, Marc Olive is the hospital’s only full-time physical therapist working exclusively in the emergency department. On a recent shift, he moved through hallways checking with doctors and nurses to see which patients might benefit from physical therapy.
“I teach precautions — movement precautions, lifting precautions — and I also like to address pain management,” Olive said. “How do we manage your pain while this is happening?”
One of Olive’s patients was Izabella Hutton, who came to the ER after being rear-ended while pulled over on the side of the road. Olive examined her, asked about the crash and explained how posture and movement could affect her neck pain before ordering imaging tests.
Unlike traditional outpatient clinics, Olive’s role was created as part of a research study testing whether earlier physical therapy could reduce opioid use among ER patients.
For around three decades, research has showed high satisfaction among physicians, advanced practice providers and patients, with outcomes similar to programs already in place in Australia and the United Kingdom.
“Most ERs around the country, opioid use was pretty high [around the turn of the 21st Century],” Olive said. “After bringing physical therapy into the ER, we’re still treating pain, but prescriptions are smaller, and we’re using more alternatives.”
The MU study followed 974 patients between 2020 and 2022. Researchers found average pain scores dropped significantly by the time patients were discharged.
Julie Stilly, a researcher with Mizzou’s Department of Emergency Medicine, said musculoskeletal pain is one of the most common complaints seen in emergency rooms.
“These patients were living with a lot of pain while waiting weeks or months for physical therapy appointments,” Stilly said. “When we received funding, it was the perfect opportunity to give patients care right in the emergency department.”
The study offered patients up to 20 free follow-up physical therapy visits after discharge. Still, many did not continue treatment. Even so, Stilly said among patients who completed the full follow-up period, none were using opioid prescriptions any longer.
“Our biggest win is that patients who received physical therapy in the emergency department were less likely to come back later with the same complaint,” she said.
Although the study ended three years ago, its findings led the hospital to make Olive’s position permanent. He said he sees the strongest results among patients with vertigo and lower back pain.
“I’ve had patients come in with pain levels of eight or nine out of 10,” Olive said. “By the time I’m done, they’re at a two or three, which is a huge change.”
Opioids are still prescribed in some cases. But at MU Health Care’s emergency department, doctors increasingly rely on alternatives — including physical therapy, muscle relaxers and non-opioid medications — a shift researchers say is helping change how pain is treated in emergency care.
