Take Home Messages:

Home exercise programs are cheap and effective in reducing pain and improving fitness.  

However a home exercise program will not have any effect on disability or psychological state.

The addition of physical therapy will provide improvement in disability and psychological condition.

Increased levels of fitness are associated with decreased pain – and decreased fitness with increased pain.

Why the research matters: 

Low back pain affects 50-80% of the population over a lifetime. Low back pain is classed as chronic if it lasts for more than 3 months.

Chronic back pain causes psychological problems, disability and deterioration in quality of life.

Chronic back pain has a financial impact through reducing the manpower of affected individuals, and the cost of diagnostic procedures, repetitive treatments and other related treatment costs.

Current treatment regimes promote active participation by patients. There have been many new approaches developed for the management of back pain and there is confusion about which type of therapy is best.

Traditional markers for improvement for back pain include spinal mobility, pain severity, disability and psychological status. Recently aerobic capacity – a measure of a person’s fitness – has been found to be a reliable indictor of improvement.

What the research involved:

The authors assessed the following three types of treatment over a 6 week period, and at a 1 month follow up:

1. Group 1 - Home exercise and aerobic exercise
2. Group 2 - Home exercise and physical therapy (hot packs, ultrasound and electronic nerve stimulation treatment)
3. Group 3 - Home exercise only

These are all examples of programs that might be used by physiotherapists.

Sixty study participants were randomly allocated into one of the groups and the following outcomes were measured:

• Pain;
• Spinal mobility;
• Disability;
• Psychological state; and
• Aerobic capacity.

The authors wanted to determine if there were any differences in the outcomes of the various treatments.

Summary of research findings:

Home exercise improves pain levels during therapy and for at least one month afterwards. It also improves aerobic capacity (exercise ability).

The addition of extra activities or therapies did not alter the degree of pain reduction.

The physical therapy group (2) were more likely to report:

• Improvements in their depressive symptoms; and
• Lower degrees of disability.

After one month, groups 1 and 2 reported a significant improvement in their general state of health.

Original research:

Comparison of three different approaches in the treatment of chronic low back pain

KoldaÅŸ DoÄŸan S, Sonel Tur B, KurtaiÅŸ Y, Atay MB.

Clin Rheumatol. 2008 Jul;27(7):873-81. Epub 2008 Jan 11.

Link to PubMed abstract