Physical Therapy No More Effective for Back Pain Than Expert Advice
Back pain is a leading cause of disability in both the United Kingdom and the United States. Physical therapy for back pain is an individualized intervention that uses physical and mechanical means of treating injuries, including heat, cold, massage, mobility, and therapeutic exercises.
Health care providers generally advise their patients with low back pain to avoid re-injury, remain physically active, and take medications for the pain. In addition, many recommend physical therapy despite the fact that only weak evidence supports it as an effective treatment.
A new study in the September 17, 2004 issue of the British Medical Journal suggests that sessions of physical therapy are no more effective in treating ]]>low back pain]]> than a session of advice from a physical therapist.
About the Study
Researchers from Warwick Medical School in the United Kingdom recruited 286 people from the British National Health Service (NHS) who were suffering from mild to moderate low back pain, excluding people with serious medical conditions that resulted in back pain.
The participants, who were selected from seven NHS physical therapy departments, were randomly assigned to either a treatment group (144 people) or an advice group (142 people), and followed for one year. The majority of people in the treatment group received five sessions of routine physical therapy. Most people in the advice group received a one-hour counseling session promoting regular activity and pain management.
As each person was enrolled in the study, the researchers assessed each participant’s level of disability using a tool called the “Oswestry disability index.” After two, six, and 12 months, participants were reassessed using the same tool, so the researchers could see if there were any improvements in disability levels. In addition, participants were asked to rate on a scale of 1–10 whether they perceived they were improving either with the physical therapy or the advice they received.
After adjusting for differences in age, sex, smoking status, and time since first episode of back pain, the researchers found that disability scores did not differ between the physical therapy treatment group and the advice group after 12 months. These results suggest physical therapy for the treatment of low back pain is no better than advice in the long run. However, participants in the therapy group were more likely to report perceived benefits from treatment than those people in the advice-only group.
Although these results are interesting, there are limitations to this study. First, 30% of participants dropped out before 12 months. However, the researchers addressed this problem by assuming the last disability score measured in these participants stayed the same until the end of the study when the analysis was completed.
Second, physical therapists were allowed to decide which method of physical therapy to use with each participant. There are many different exercises and techniques, and it is possible that some may be more effective than others. The study, however, may not have detected the effectiveness of any of the better techniques if several ineffective and effective treatments were included in the same analysis.
Similarly, due to a high turnover rate of health care providers in the British NHS, there were a large number of physical therapists performing only a small number of therapy sessions. Some may have had less experience than others, which might have led to lower disability scores in some participants. And more sessions have shown better results for the treatment group.
Finally, approximately 26 of the 142 people in the advice-only group received additional sessions beyond the one intended, which may have made the treatment and advice groups too similar to detect any differences in disability scores.
How Does This Affect You?
This study suggests that people suffering from mild to moderate low back pain may not benefit any more from physical therapy than if they were instructed to participate in therapeutic exercises in the comfort of their own home.
However, back pain is a difficult problem to treat. There are many different causes of back pain and many different possible treatments. The best advice continues to include visiting your doctor to discuss the cause of your back pain and the best treatment options for you. In the long run, though, these results do challenge the use of routine physical therapy for the treatment of low back pain.
American Chronic Pain Association
National Institute of Neurological Disorders and Stroke
Frost H, Lamb SE, Doll HA, et al. Randomised controlled trial of physiotherapy compared with advice for low back pain. British Medical Journal . 2004;329:708–711.
MacAuley D. Back pain and physiotherapy . British Medical Journal . 2004;329:694–695.
Last reviewed Oct 1, 2004 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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