Back Pain Physiotherapy
Objective: To measure the effectiveness of routine physiotherapy compared with an assessment session and advice from a physiotherapist for patients with low back pain.
Design: Randomised, controlled, multicentre, pragmatic trial.
Setting: 7 British NHS physiotherapy units.
Participants: 286 people with lower back pain lasting more than 6 weeks.
Intervention: Routine physical therapy, advice to keep active and from a certified physiotherapist. Both the groups were provided with an advice book.
The Oswestry Disability Index at 12 Months was the main outcome. Secondary outcomes were Oswestry disability scores at six and twelve months and Roland and Morris disability questionnaire scores and SF-36 scores (6 and 12 month), as well as patient perceptions of treatment benefit (3-6 and 12 months).
Results: 200 out of 286 (70%) patients provided 12-month follow-up data. Patients in the therapy group reported enhanced perceptions of benefit, but there was no evidence of a long term effect of physiotherapy in either disease specific or generic outcome measures (mean difference in change in Oswestry disability index scores at 12 months -1.0%, 95% confidence interval -3.7% to 1.6%). These treatments included low velocity techniques to mobilize the spinal joints (72% in 104 patients) as well as lumbar mobility and abdominal strengthening exercise (94% in 136 patients).
Conclusion: Routine physiotherapy did not seem to have the same effectiveness as one session of advice and assessment from a physical therapist.
MacAuley D. MacAuley D. BMJ. 2004 Sep 25;329(7468):694-5. doi: 10.1136/bmj.329.7468.694. BMJ. 2004. PMC Article: Free PMID: 15388588 It is not possible to provide an abstract.
Low back pain advice compared to physiotherapy:
Bartley R. Bartley. 2004 Dec 11;329(7479):1402-3; discussion 1403. doi: 10.1136/bmj.329.7479.1402-b. BMJ. 2004. PMID: 15591571 Free PMC article. There is no abstract.
A comparison of advice on low back pain and physiotherapy.
Doherty D. Doherty D. BMJ. 2004 Dec 11;329(7479):1402; discussion 1403. doi: 10.1136/bmj.329.7479.1402-a. BMJ. 2004. PMC Article: Free PMID: 15591572 This abstract is unavailable.
Comparison of physiotherapy and advice on low back pain. Physiotherapy is not evidence-based.
Simmonds M, Daykin A. Simmonds M, et al. BMJ. 2004 Dec 11;329(7479):1402; discussion 1403. doi: 10.1136/bmj.329.7479.1402. BMJ. 2004. PMC Article: Free PMID: 15591573 It is not possible to provide an abstract.
Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. In this study, we examined the effects of combined physiotherapy treatments that combined all these methods. Hidden randomisation was used to allocate 57 patients suffering from chronic low back pain to the four-week program of physiotherapy or to management according their doctors. The dependent variables of interest were pain and disability. Blind to the treatment group, assessors weren’t able to see. Data from 49 subjects (86%) revealed a substantial treatment effect. A physiotherapy program decreased pain and disability by 1.5/10 points each on a numerical rating scale (95 % CI 0.7- 2.3) and 3.9 on the Roland Morris Disability Questionnaire (18 % CI 2-5.8) respectively. Three (95% CI 3-8 pain), and two (95% CI 5 to 5) to achieve clinically significant changes in disability was the minimum number that needed to be addressed. One-year after treatment, the effect of the therapy was still evident. This study supports the efficacy and effectiveness of combined therapy in producing both symptomatic as well functional changes in chronic low back pain sufferers with mild to moderate disability.
The pragmatic randomized controlled trial looked at manual therapy, exercise, and education for low back pain.
Cuesta – Vargas AI, Garcia – Romero JC, Arroyo—MoralesM, Diego-AcostaAM, Daly DJ. Cuesta-Vargas AI, et al. Am J Phys Med Rehabil. 2011 Jul;90(7):526-34; quiz 535-8. doi: 10.1097/PHM.0b013e31821a71d0. Am J Phys Med Rehabil. 2011. PMID: 21765272 Trial.
The randomized, controlled trial of spinal manipulation in the treatment and prevention of chronic low back pain. One-year followup.
Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, Macchi C. Cecchi F, et al. Clin Rehabil. 2010 Jan;24(1):26-36. doi: 10.1177/0269215509342328. Clin Rehabil. 2010. PMID=20053720 Clinical Trial.
This randomized controlled trial investigated the effectiveness of musculoskeletal rehabilitation on chronic low back disorders.
Goldby LJ. Moore AP. Doust JS. Trew Me. Goldby LJ, et al. Spine (Phila Pa 1976). 2006 May 1;31(10):1083-93. doi: 10.1097/01.brs.0000216464.37504.64. Spine (Phila Pa 1976). 2006. PMID: 16648741 Clinical trial
Combine manual therapy with pain neuroeducation education in chronic low backache: A narrative analysis of the literature.
Puentedura EJ, Flynn T. Puentedura EJ, et al. Physiother Theory Pract. 2016 Jul;32(5):408-14. doi: 10.1080/09593985.2016.1194663. Epub 2016 Jun 30. Physiother Theory Pract. 2016. PMID: 27362980 Review.
[Physiotherapy and Rehabilitation for Low Back Pain].
Bachmann S, Oesch P. Bachmann S, et al. Ther Umsch. 2013 Sep;70(9):543-8. doi: 10.1024/0040-5930/a000444. Ther Umsch. 2013. PMID: 23985153 Review. German.
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Leake HB. Simons LE. Heathcote LC. Simons LE. Stinson I. Kamper SJ. Williams CM. Burgoyne LL. Craigie M. Kammers M. Moen M. Pate MW, Szeto KW. Moseley GL. Leake HB, et al. Can J. Pain. 2019 Nov 26;3(1):200-208. doi: 10.1080/24740527.2019.1682934. eCollection 2019. Can J. 2019. PMC Article Free of Charge
Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial.
Gul H, Erel S, Toraman NF. Gul H, et al. Turk J Phys Med Rehabil. 2021 Sep 1;67(3):283-290. doi: 10.5606/tftrd.2021.5556. eCollection 2021 Sep. Turk J Phys Med Rehabil. 2021. PMC Free Article
Management of Traumatic Shoulder Instability in Physiotherapy (MASIP: A Survey of Physiotherapy Practice).
Coulthard C. Cairns MC. Williams D. Hughes B. Jaggi. Jaggi. Coulthard C. et.al. BMC Musculoskelet Disord. 2021 Sep 30;22(1):840. doi: 10.1186/s12891-021-04677-9. BMC Musculoskelet Disord. 2021. PMID: 34592969 Free PMC article.
Effect of pain neuroscience education and exercise on presenteeism and pain intensity in health care workers: A randomized controlled trial.
Imai R, Konishi T, Mibu A, Tanaka K, Nishigami T. Imai R, et al. J Occup Health. 2021 Jan;63(1):e12277. doi: 10.1002/1348-9585.12277. J Occup Health. 2021. PMC free article. PMID 34587662 Clinical Trial
Low back pain and exercise are the best treatments.
Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Hayden JA, et al. Cochrane Database Syst Rev. 2021 Sep 28,9(9).CD009790. doi: 10.1002/14651858.CD009790.pub2. Cochrane Database Syst Rev. 2021. PMID: 34580864 Review.
Exercises and Stretches to the Back
Simple back exercises and stretches can often help reduce back pain. You can do these at your home whenever you feel like it.
For information about exercises and stretches that can help, see:
and Arthritis: How to Manage Back Pain
If you have any questions about exercises for your back, your GP could be able provide guidance. Alternatively you can consult a physiotherapist to get advice. You can learn more about how you can get access to physiotherapy. Regular stretching, along with the stretches mentioned above, will help your back stay strong and healthy. Popular options include pilates, swimming and yoga.
Global disability is largely caused by non-specific low back pain. Multiple-disciplinary pain treatment (MPT), programs that combine educational, physical, as well psychological interventions has shown positive effects on LBP. These programs are however expensive, and there are limited options for treatment. The potential for mHealth or other digital interventions to support LBP patient self-management may be promising. We addressed these concerns by investigating the clinical results of a multi-disciplinary mHealth backpain App (Kaia App), in a randomized controlled experiment (registered at German Clinical Trials Register, under DRKS00016329). Randomly, one-hundred and one adults with non-specific LBP (from 6 weeks to 1 years) were assigned to either an intervention or control group. For 3 months, Kaia Apps were provided to the intervention group. Six sessions of physiotherapy were given over six weeks. High-quality education was also provided online. An 11-point numeric rating system (NRS) was used to assess the pain intensity at 12 weeks. The per-protocol analysis revealed no differences in the baseline groups (Kaia App Group: M = 5,10 (SD = 1,077) and control group:M = 5,41 (SD = 1,15). Kaia App reported significantly lower pain intensity (12-week follow up) than the control group. M = 2.70(SD = 1.51) was lower than that of the Kaia App (M = 3.40; SD = 1.63). The Kaia App, a multidisciplinary app for back pain treatment, is more effective than physiotherapy and online education.
After demonstrating the effectiveness of Kaia App, we performed posteriori response analysis in order to obtain the primary outcome. D pain score scores were subtracted from the baseline values of patients to get a percentage score for pain relief. We then gathered response rates below 15% to 15-29%, 30-49, 30%, 49% and 50%. The distribution of patients among the four groups was the same, X2 (3) = 3.33, and p = 0.3444. However, it is clear that the Kaia App group overrepresented the >50%, while the control group shows a peak not only in the 30-49 but also the 15% (Fig.
). At 6-week follow-up three and four patients reported no current back pain in the intervention and control group, respectively. After 12 weeks, 14 and 7 patients did not report any back pain during the intervention or control groups.
Response analysis: The percentage (relative frequency of) patients who reported a reduction in pain from baseline to 12 weeks after treatment. This is compared for each group (N = 42 and N = 44). Analysis of the primary outcome did not yield significant results.
In recent years the physiotherapy profession underwent a paradigm shift. A ‘biopsychosocial model’ of care gained popularity due to increasing research that shows better outcomes for patients when combined with traditional physiotherapy. Researchers have not yet examined the implementation of this new model in traditional physical therapies within therapeutic consultations.
It was conducted to evaluate physiotherapists’ back pain care strategies under increasing pressure from patients to take into account their psychosocial needs. Semi-structured interviews were used to conduct secondary analyses with twelve UK registered physiotherapists. Respondents were sampled from a national survey, to include a broad mix of physiotherapists. Data were analysed by thematic analysis using the constant comparative technique.
A combination of physical therapy, as well as a more holistic biopsychosocial approach to treatment presented unique challenges. With a wide range of strategies available, physiotherapists tried to resolve patients’ biopsychosocial difficulties.
As psychosocial issues, alongside biomechanical factors, command a prominent place within the back pain consultation, physiotherapists may benefit from further specific training and mentoring support in identifying specific strategies for combining the best of traditional physiotherapy approaches with greater focus on patients’ beliefs, fears and social context.
Theme 1 – Perceived Obstacles to Recovery
Psychosocial factors LBP were thought to be important because they can cause anxiety, panic and fear in patients. The physiotherapists addressed these feelings by trying to resolve them. They recognized that such reactions were quite common for people with LBP. But, they felt they had to address them and offer comfort to patients.
B5332 – This comes from experience. You know that patients can panic, and there is fear. They have no clue. It could be very serious. This could not be.” I believe they are looking for someone to tell them “Look, this isn’t serious. It’s just mechanical. We can help you.” Patients’ beliefs regarding the causes and manifestations LBP were thought to play a significant role in managing physical symptoms. While physiotherapists recognised the psychosocial aspects of the LBP experience and the associated link with these factors and chronicity, they claimed to lack sufficient training to effectively address these concerns with patients.
5960: But I’m not claiming that I can help all those patients. What I’m referring to is my capacity to provide counselling and to aid them in their lower back pain. So, and in those cases if it’s outside my area of outside my boundaries if you like, I tend to involve other professionals as well.
This therapist was aware of the critical importance to deal with psychosocial concerns. However, physiotherapists struggled to find strategies to integrate the clinical explanations within a broader biopsychosocial framework that made sense to patients.
LBP LBP has often been associated with work absenteeism. Therefore, it is possible that the wider cultural contexts influenced our respondents’ attitudes toward some patients and reinforced their belief that only physiotherapy could help. Some physiotherapists stated that LBP made certain patients financially dependent. Following respondent mentioned that it is possible for patients who receive financial support to treat their back pain and disability to be less inclined to take physiotherapy advice seriously.
B5332 – They might be getting their own rewards, and they’ll make more money that way than if they go back to work.
Interviewer: Right, right. This makes it sound, well, pretty.
B5332: Yes, although it is true that I say so, it is very difficult to prove. It’s all speculation. Patients can’t be accused of doing anything you don’t know.
.Back Pain Physiotherapy
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