Early physical therapy provides only modest benefits for low back pain, and the discomfort usually subsides by itself, a new study has found.
The study followed more than 200 people with recent-onset low back pain who were randomly assigned to physical therapy or no treatment for the first month after their pain began. Physical therapy included back manipulation and exercise.
Stay active and exercise
Early physical therapy produced a modest improvement in the study participants' ability to function after three months, compared with no physical therapy. However, after a year, no significant difference in function was found between the two groups.
And the participants reported no improvement in pain after one month, three months or one year of therapy, the researchers said.
"People with lower back pain tend to get better quickly, and the physical therapy helped them get there a little quicker," said lead researcher Julie Fritz, a professor of physical therapy at the University of Utah.
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"But the difference between the improvement that comes with time and the improvement that comes with therapy is not a huge difference," she said.
The best treatment for low back pain is to stay active and exercise even though it's painful, Fritz said. "The goal is to keep people moving to help them recover, and that often happens without assistance," she added.
Low back pain afflicts about 70 percent of people in their lifetime and accounts for 2 percent to 5 percent of all doctor visits, according to background notes in the study.
A very complex problem
The study was published in the issue of the Journal of the American Medical Association.
"Chronic back pain is a very complex problem influenced by many psychological, social and medical factors," said Edward Michna, director of the pain trials centre at Brigham and Women's Hospital in Boston.
It makes sense to be as active as possible when new back pain occurs, and early physical therapy can assist, he suggested. "But the physical therapy does not change overall long-term outcomes and does not prevent back pain-related disability in the long term," said Michna, who was not involved with the study.
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Current guidelines advise delaying physical therapy for a few weeks to permit spontaneous recovery, the study authors said, but other recent research has suggested early physical therapy could be beneficial.
The new study results aren't an indictment of physical therapy. It can be useful for someone who needs assistance starting to exercise or staying active while recovering from back pain, Fritz said. In such cases, "physical therapy can help accelerate the process a little bit," she said.
And physical therapy won't be harmful, said Anthony Delitto, professor and chair of physical therapy in the School of Health and Rehabilitation Sciences at the University of Pittsburgh.
"If you'd rather try that than drugs or anything else, it's certainly worth a try," Delitto said.
He also advises people to remain active. "That's counter to what we were telling people 20 years ago. People were told to go to bed, and that is clearly something they should not do," Delitto said.
However, patients shouldn't go to physical therapy expecting a cure-all, Delitto added. "If you're willing to sit it out, you're likely to get better without it," he said.
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