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FURTHER RESEARCH SUPPORTS INDIVIDUALISED TREATMENT FOR LOW BACK PAIN

Yet more research has shown that one to one physical treatment is effective for many different types of low back pain. The following article appeared in Medscape.

NEW YORK (Reuters Health) – Customized physical therapy may provide more relief for lower back pain than general advice on the best ways to remain active, an Australian study suggests.

Researchers offered 300 patients with lower back pain two advice sessions explaining the source of their discomfort and providing instruction on proper lifting techniques. Roughly half of them also got 10 treatment sessions of personalized physical therapy over 10 weeks.

The physical therapy group had significantly greater reductions in activity limitations at 10, 26, and 52 weeks than the advice group and they also had less back pain at 5, 10, and 26 weeks.

“Our findings suggest that advice works for many people but that individualized physical therapy achieves more rapid reduction in pain and, in the long term, superior improvements in function/disability,” lead author Dr. Jon Ford of La Trobe University in Bundoora, Australia, told Reuters Health by email.

Low-back disorders are common and many patients with acute problems have persistent symptoms for at least a year, Dr. Ford and colleagues note in an article online October 20 in the British Journal of Sports Medicine.

To be included in the study, patients needed to have experienced pain for six weeks to six months and have one of five specific types of back pain: disc herniation, reducible disc pain, non-reducible disc pain, joint pain, or multifactorial persistent pain.

Patients assigned to customized physical therapy in the study used specific exercise techniques tailored to the type of injury and individual barriers to recovery. Some, for example, focused on posture and lifting to ease disc pain, while others with disc herniation worked on motor control targeting specific muscle groups.

Participants in both the advice and the physical therapy groups improved over time, but the people who received the customized exercise sessions generally did better.

One shortcoming of the study is that the advice group had far fewer encounters with health providers than the physical therapy group, the authors acknowledge.

“There was an 8-session difference in treatment groups, so there was a notable difference in provider attention that could account for some of these group differences,” Dr. Steven George, a physical therapy researcher at the University of Florida who wasn’t involved in the study, told Reuters Health by email.

In addition, the differences in outcomes between the two groups aren’t that large, as is often the case in studies of back pain, Julie Fritz, associate dean for research at the College of Health at the University of Utah in Salt Lake City, told Reuters Health by email.

“Back pain is very common and many patients are advised to attend physical therapy at some point,” Fritz said. “The challenge for researchers is to continue to examine which particular physical therapy interventions work for specific types of patients with low back pain and determine the optimal timing for physical therapy intervention.”

LifeCare Health supported this research and employed six coauthors during the study.

SOURCE: http://bit.ly/1PoQKkC

Br J Sports Med 2015.

Richard Katesmark comments, “ Obviously from my perspective the results are no surprise. It is noteworthy how effective simple advice can be, however I would expect the improvements between the two groups to be even more marked had the participants in the trial had more complex/longstanding low back problems, requiring an expert ‘bespoke’ approach “