Is physiotherapy YOUR cure for chronic low back pain? Researchers say that depends…

Physiotherapy is the standard non-surgical treatment for chronic low back pain, but it doesn’t work for everyone.  New research identifies factors that predict how well a patient will respond to treatment.

Physiotherapy is recommended for low back pain

A conservative approach to treating chronic non-specific low back pain is recommended by current health practice guidelines.  This includes exercise therapy and patient education, which enjoys strong clinical support, and to a lesser degree various other physiotherapy treatment modalities such as nerve mobilization procedures, and traction or ‘spinal decompression therapy’ (see “Traction doesn’t help lower back pain”). As an interesting aside, some physicians in the United States appear to be ignoring these guidelines in favour of incorrectly prescribing narcotics, imaging, and specialist referrals instead, see: “Incorrect treatment of back pain is on the rise“.

For the latest research on which lower back pain therapies appear work, and which don’t, check out our new post: “New research for preventing recurrence of lower back pain: 2 do’s and 5 don’ts“.

The majority of cases of chronic low back pain do not spontaneously resolve on their own (ref1).  Physiotherapy is typically recommended as the first option for treatment, but non-specific chronic low back pain is comprised of a heterogeneous collection of clinical conditions (ref2), so it is not surprising that not everyone responds well to treatment.  For cases that don’t see improvement with conservative treatment, surgical options may be considered, but improved outcomes are by no means ensured (see “Physiotherapy as effective as surgery for degenerative disc disease”).

So physiotherapy is recommended, and tends to be effective, but not always. Will it work for me?

But will physiotherapy work for MY chronic low back pain?

A new study sheds light

A new study published this month tried to answer this question, or more precisely, tried to identify predictors of positive functional outcomes immediately following physiotherapy discharge, and 1 year later (ref3).  Participants in the study received seven 45 minutes sessions of physiotherapy which included individualized treatment along with an exercise program for the patient to continue performing following their discharge from physiotherapy.  The authors examined patient reported disability scores for the 211 patients who completed treatment and returned for follow up 1 year later.

Overall, individually designed exercise therapy programs were found on average to generate clinically significant functional improvements at both discharge and at 1 year follow-up, which agrees with previous studies.  As expected, some patients did not respond well to treatment. Not surprisingly, patients who reported ‘severe’ back pain intensity upon initiation of treatment had the lowest likelihood of positive outcomes at the time of discharge.

The authors also found that younger age and better mental health were strong predictors of good outcomes at the one year mark, while use of painkillers and previous low back pain treatments predicted poor outcomes.

The most important factor that predicted good outcomes at 1 year post-discharge was adherence to the provided exercise therapy program.

Adherence to the prescribed exercise therapy program was found to improve the probability of good outcomes by nearly double!  In contrast, overall physical activity levels did not appear to correlate well with functional improvement.

What should I take away from this research?

Physiotherapy (specifically, individualized exercise therapy programming) is the standard treatment for non-specific chronic low back pain, and the majority of patients will respond to this treatment with decreased pain and reduced functional disability.

Factors that appear to increase the chance that physiotherapy will work for you:

1. Good mental health
2. Youth (lucky you)
3. NOT having had previous failures to control your back pain through prior treatments and medication
4. Adherence to your prescribed exercise therapy program

If you can commit to following a simple customized exercise therapy program, your chances of success double!

References

1. Airaksinen O., Brox J.I., et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15(Suppl 2):S192-S300.
2. Fourney D.R., Andersson G., et al. Chronic low back pain: a heterogeneous condition with challenges for an evidence-based approach. Spine (Phila Pa 1976) 2011:36(21 Suppl):S1-S9.
3. Cecchi F., Pasquini G., et al. Predictors of response to exercise therapy for chronic low back pain: results of a prospective study with one year follow-up. Eur J Phys Rehabil Med. 2014 Jan 16. [Epub ahead of print].