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  • Study: For Best LBP Results, Take a PT's Advice – Plus Customized Physical Therapy

    The role of education and advice in the treatment of low back pain (LBP) may be important, but it's probably not as effective as coupling that advice with physical therapy that's been "individualized" to the particular kind of LBP a patient is experiencing, according to a new study from Australia.

    Researchers focused on 300 patients, aged 18-65 (average age, 44.2) who had experienced LBP for between 6 weeks and 6 months. They split participants into 2 groups: 1 group received 2 30-minute education and advice sessions provided by a physical therapist (PT), plus 10 30-minute physical therapy sessions over 10 weeks; the other group received the education and advice sessions only. Results were e-published ahead of print in the British Journal of Sports Medicine (abstract only available for free).

    Previous research has taken a similar approach, but what makes the latest study different is that the physical therapy participants were further subdivided into 5 groups based on the nature of their LBP: disc herniation with associated radiculopathy, reducible discogenic pain, nonreducible discogenic pain, zygapophysical joint pain, and multifactorial persistent pain. Each group received an "individualized" treatment protocol during the 10 sessions. Those treatments were:

    Reducible discogenic pain—home exercise and postural reeducation program "based on mechanical loading strategies"

    Zygapophysical joint pain—targeted manual therapy

    Disc herniation with associated radiculopathy and nonreducible discogenic pain (2 groups)—motor control training leading to a functional exercise program

    Multifactoral persistent pain—physical therapy "focusing on psychosocial and neurophysiological rather than pathoanatomical mechanisms"

    In every subgroup, participants receiving physical therapy reported better function outcomes than their advice-only counterparts at 10, 26, and 52 weeks after treatment, as well as better back and leg pain outcomes at 5, 10, and 26 weeks. Researchers estimated that the participants receiving physical therapy had a 1.8 times greater chance of improving back pain by 50% or more compared with the advice group. The chance of a 50%-or-more improvement in leg pain was estimated at 1.6 times that of the advice group.

    While all groups registered improvements that met standards for minimally clinically important difference (MCID), the difference between the physical therapy and advice-only groups did not meet the MCID threshold for primary outcomes. Authors of the study characterize the differences as "statistically significant," and argue that "the MCID was developed for use on individuals, and application to mean between-group differences may not be appropriate."

    "Given the population sampled were [6 weeks or more] postinjury where spontaneous recovery is limited, it is likely that both treatments were effective, with [individualized physical therapy] conferring additional benefits over and above advice," authors write.

    The newest study is 1 of several recently published studies that have looked at the relationship between physical therapy and LBP. Another study, published in October, looked at 1-year outcomes for individuals with LBP who received education and early physical therapy, and compared those with outcomes for individuals who received only PT-led education. In that study, researchers found few differences in outcomes between the 2 groups.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • In my experience (38 years of clinical practice, 7-8K back pain patients and 50 years researching the pelvis. I discovered the sacral axis in 2006) if you can't have nearly every back pain patient free of pain in about 10-15 minutes you are hurting them and prolonged mistreatment will cause chronicity. Please refer them elsewhere. I have told many patients that if I could not have them free of pain at the conclusion of the session that I would not charge them for the treatment. I charged them all. You must learn about the subluxation of the sacral axis, lateral sacral flexion, balanced ligaments, force couples, anterior innominate rotation, etc. 1. Norman G F, May A. Sacroiliac conditions simulating intervertebral disc syndrome. West J Surg Obstet Gynecol. 1956.461-462 2.Tingren J, Soinila S. Reversible pelvic asymmetry. J Manipulative Physiol Ther. 2006 29(7):561-5. 3. Davis P, Lentle PC. Evidence for sacroiliac disease as a common cause of low backache in women. Lancet. 1978. 2:496-97. 4. Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S. Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study. J of Orthopaedic Science. 2007. May; 12(3):274-280.

      Posted by Richard DonTigny, PT on 12/11/2015 10:49 PM

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