Orthopedic · Kauai
Physical therapy for low back pain in Kauai
Low back pain is the most common reason adults see a physical therapist, and for the large majority it is a movement problem, not a structural one. Guided exercise is the treatment with the strongest evidence, and it works by video.
- TRICARE, HMSA, and HMSA QUEST in-network
- No state referral requirement; some plans need one
- Video visits anywhere in Kauai
About the condition
Low back pain: what is going on.
Most low back pain is not caused by a damaged disc or a bone out of place. It comes from how the back is being loaded: long sitting, a weak or stiff hip, a brace pattern that never lets go, a lifting habit, or a flare after an unfamiliar activity. Imaging findings like bulging discs and degeneration are common in people with no pain at all. That is why guidelines recommend staying active and starting physical therapy early, before pain settles into a pattern.
Orthopedic physical therapy for low back pain assesses how the person bends, lifts, sits, and walks, finds the movements that relieve and the ones that provoke, and builds a program from there.
Common experiences
What people with low back pain often describe
These are the patterns Dr. Shalem hears most often. Any of them is a reason to book a discovery call.
Pain that builds with sitting or with standing too long
Stiffness in the morning or after driving
Pain with bending, lifting, or getting out of a chair
Recurrent flare-ups a few times a year
Pain that spreads into the buttock
Fear of making it worse with exercise
Treatment
How physical therapy addresses it.
The program pairs specific exercises that reduce pain with hip and core strengthening, teaches lifting and sitting mechanics, and progresses to the patient's work and sport. Pacing, sleep positions, and flare planning are included. Red flags that need medical evaluation are screened at the first visit.
What a video visit looks like
Dr. Shalem watches the patient bend, squat, and walk on camera, uses guided self-tests to find what helps, and progresses the program each visit with form checks. Most back pain plans need no equipment beyond a mat.
Coverage in Hawaii
Insurance and pricing
Bring your plan name to the discovery call and we confirm your physical therapy benefit before the first visit.
TRICARE
In-network (TRICARE West). TRICARE Select members can book directly with no referral. TRICARE Prime members need a referral from their primary care manager, and we tell you exactly what to ask for.
HMSA
In-network with HMSA PPO and HMO plans. Some HMSA plans require a referral from your primary care provider; we check yours before the first visit.
HMSA QUEST
In-network with HMSA QUEST (Hawaii Medicaid). We confirm coverage before your first visit.
Private pay
Available for any other plan. HSA and FSA cards accepted.
Referrals
Hawaii allows you to start physical therapy without a physician referral. Your insurance plan may still ask for one (TRICARE Prime and some HMSA plans do), and we check that for you before the first visit.
All of Kauai is seen by video, including military families at Pacific Missile Range Facility Barking Sands.
How it works
How a virtual visit works
Dr. Shalem watches the patient bend, squat, and walk on camera, uses guided self-tests to find what helps, and progresses the program each visit with form checks. Most back pain plans need no equipment beyond a mat.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Questions
Low back pain questions in Kauai
Do I need an MRI first?
Usually not. Guidelines recommend against routine imaging for low back pain without red flags, because findings rarely change treatment. Dr. Shalem screens for the signs that do need imaging at the first visit.
Should I rest or move?
Move. Staying active, within tolerance, speeds recovery more than rest. The program shows which movements to use and which to ease off for now.
Can video physical therapy work for back pain?
Yes. Trials of telehealth physical therapy for low back pain show outcomes comparable to in-person care. The treatment is exercise and education, which translate directly.
Do I need a referral for physical therapy in Hawaii?
Hawaii allows you to start physical therapy without a physician referral. Your insurance plan may still ask for one (TRICARE Prime and some HMSA plans do), and we check that for you before the first visit.
What insurance do you take in Hawaii?
TRICARE: In-network (TRICARE West). TRICARE Select members can book directly with no referral. TRICARE Prime members need a referral from their primary care manager, and we tell you exactly what to ask for. HMSA: In-network with HMSA PPO and HMO plans. Some HMSA plans require a referral from your primary care provider; we check yours before the first visit. HMSA QUEST: In-network with HMSA QUEST (Hawaii Medicaid). We confirm coverage before your first visit. Private pay: Available for any other plan. HSA and FSA cards accepted.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Hawaii.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.