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Anne Asher

Back Pain - To PT or Not To PT?

By October 20, 2012

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I am always amazed when I meet a person whose doctor refuses to prescribe physical therapy for a back or neck problem.  But the truth is, there are not a lot of high quality studies that investigate how non-invasive treatments stack up against one another and/or against surgery.  (My guess is, these treatments don't benefit the bottom line of pharmaceutical and medical device companies, and as such less money goes to fund them...)

A 2009 review on the effectiveness of physical therapy treatments for chronic non-specific low back pain was published in the European Spine Journal in 2010.  This review looked at studies that compared a number of common treatments such as back exercise, back school, TENS, low level laser, massage, behavioral treatment such as cognitive behavioral therapy and more.

The results were pretty dismal, and at least for back exercise, in my opinion, not fully reflective of the truth.  The researchers found that results from exercise therapy were approximately equivalent to doing nothing.  But, when compared with going to the the doctor, exercise relieved more pain and reduced more disability in the short term.  So at least there's that perk.


If you're thinking about getting a TENS unit to help deal with the pain, think again.  The review found that TENS was no different from sham TENS treatment nor active treatment.

The review also found only low quality evidence for multidisciplinary approach to back pain treatment as compared to doing nothing.  This low quality evidence was for short term pain relief and decreased disability.

Related: Pain Management Medicine - A Multi-Disciplinary Approach

The one silver lining in this review was that behavioral therapies scored well.  The researchers found that behavioral therapy of all types helped reduce the intensity of pain.  Just the same, researchers are still debating the effectiveness of CBT for back pain, specifically.



van Middelkoop, M, et. al.   A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.  Eur Spine J 2011.  Accessed Sept 2012.

October 20, 2012 at 1:39 pm
(1) William D Charschan DC,CCSP says:

Actually, there are quite a number of high quality sources that show manipulation and exercise is far better than medication and being sedentary.

Most back problems are actually gait issues, due to body assymmetry which is why many approaches to back pain fail to offer the promised relief. If you are built asymmetrically, it will distort the pelvis and the strain because of the tightened myofascia surrounding the pelvis will create chronic back problems.

Those with back pain often are helped by manipulation, fascial release, exercises and foot orthotics.

You can understand this much better by reading the book Cheating Mother Nature, what you need to know to beat chronic pain available on Amazon.com

October 20, 2012 at 7:09 pm
(2) Tom Koch says:

A major randomized controlled trial conducted in 2008 by the British Medical Journal found that lessons in the Alexander Technique, with or without exercise, improved both pain and function for patients with chronic back pain. Alexander Technique was compared with standard medical care, which included physical therapy recommendations, and massage. Only Alexander Technique showed improvement after one year.

The full published paper along with a video is at the BMJ web site:

Disclaimer: I have been an Alexander Technique teacher since 1987, after having 10 years of constant back pain myself.

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