Physical therapies for back pain

Evidence from the Cochrane Database

E Schonstein, DT Kenny, J Keating, BW Koes
Physical conditioning programs that include a cognitive-behavioural approach plus intensive physical training (specific to the job or not) that includes aerobic capacity, muscle strength and endurance, and coordination; are in some way work-related; and are given and supervised by a physiotherapist or a multidisciplinary team, seem to be effective in reducing the number of sick days for some workers with chronic back pain, when compared to usual care. However, there is no evidence of their efficacy for acute back pain.
JA Hayden, MW van Tulder, A Malmivaara, BW Koes
Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in populations visiting a healthcare provider. In adults with subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. For patients with acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.
SD French, M Cameron, BF Walker, JW Reggars, AJ Esterman
There is moderate evidence that heat wrap therapy reduces pain and disability for patients with back pain that lasts for less than three months. The relief has only been shown to occur for a short time and the effect is relatively small. The addition of exercise to heat wrap therapy appears to provide additional benefit. There is still not enough evidence about the effect of the application of cold for low-back pain of any duration, or for heat for back pain that lasts longer than three months.
Heat treatments include hot water bottles, soft heated packs filled with grain, poultices, hot towels, hot baths, saunas, steam, heat wraps, heat pads, electric heat pads and infra-red heat lamps. Cold treatments include ice, cold towels, cold gel packs, ice packs and ice
massage.
WJJ Assendelft, SC Morton, I Yu Emily, MJ Suttorp, PG Shekelle
There was little or no difference in pain reduction or the ability to perform everyday activities between people with low-back pain who received spinal manipulation and those who received other advocated therapies.
This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.
MW Heymans, MW van Tulder, R Esmail, C Bombardier, BW Koes
There is moderate evidence suggesting that back schools are more effective for pain and function than other conservative treatments if the patients with chronic low-back pain (LBP) are from the general public, primary or secondary care. There is conflicting evidence whether back schools are more effective than placebo or waiting list controls for pain, function and return-to-work.
There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy or advice, placebo or waiting list controls, for patients with chronic LBP.
K Karjalainen, A Malmivaara, M van Tulder, R Roine, M Jauhiainen, H Hurri, B Koes
Multidisciplinary biopsychosocial rehabilitation programs (including workplace visits) seem to offer some benefit for adults with subacute low back pain, but further research on effectiveness and cost-effectiveness is needed.
Prolonged low back pain can lead to a combination of physical, psychological, occupational and social impairment. For that reason, physical rehabilitation can also include psychological, behavioural and educational interventions. This kind of "biopsychosocial multidisciplinary rehabilitation" is available as outpatient rehabilitation, or in pain clinics and rehabilitation centres. The review found moderate evidence of effectiveness from trials of this type of rehabilitation for working age adults. Although the trials showed some benefit from multidisciplinary rehabilitation which includes workplace visits, more research on effectiveness and cost-effectiveness is needed.
H Dagfinrud, KB Hagen, TK Kvien
What is the bottom line?
- Physiotherapy or exercises are helpful to people with ankylosing spondylitis.
- There is "silver" level evidence that home exercises are better than no exercises and improve movement in the spine and fitness. Group exercises are better than home exercises and improve pain, stiffness, movement in the spine and overall well-being. Adding a few weeks of exercising at a spa resort to weekly group exercises is better than just weekly group exercises.
- We still need more information about the different types of physiotherapy and exercise, and how long and how often physiotherapy should be done for the most improvement.