- Your Bridge to Health -

Surgery is not found to be more effective for treating injuries
August 2, 2017

Many patients who have surgery go on to experience long-term complications

The rotator cuff is a network of tendons and muscles in the shoulder that keep it stable and allow it to move in a variety of directions. Due to its frequent use, the rotator cuff is also a region that is frequently injured, especially in certain athletes and older adults. It’s estimated that at least 10% of the population over the age of 60 experiences tears of the rotator cuff, which can seriously limit a patient’s ability to function normally. Treating rotator cuff tears is normally done either with surgery or with a non-surgical (conservative) approach. Physical therapy is commonly used as one of the major conservative treatments for these injuries. Although there is no clear evidence to support either of these approaches as being more effective than the other, the rates for surgery to treat rotator cuff tears has increased substantially in recent times. In addition, it’s been reported that within 1-3 years after surgery, between 20-90% of patients remain unhealed or go on to tear their rotator cuff again. Based on this, it appears that more information is needed to show whether surgery or conservative treatment is more effective for these injuries. Therefore, a powerful study called a meta-analysis was conducted, which analyzed all available research on the topic to determine which of these treatments should be used.

Six medical databases are searched for relevant studies

To conduct the meta-analysis, researchers looked through six major medical databases for studies that compared surgery to conservative treatment for rotator cuff tears. All studies that appeared relevant were assessed in detail to decide if they fit the necessary criteria. Out of the 319 studies that were identified, only three fit these criteria and were accepted for the analysis. All three were randomized-controlled trials (RCTs), which are considered the highest-quality type of individual study that can be performed. These three RCTs included data on 252 patients in total, and they were analyzed and compared to the one another with the goal of reaching a conclusion on the best possible treatment.

No important differences found between two treatments

Results showed that after one year, no significant differences were found between patients who had surgery compared to those who had conservative treatment. This was determined based on scores for two separate measurements used for overall pain and function, as patients reported similar scores regardless of which treatment they had. The findings of this meta-analysis suggest that surgery is no more effective than conservative treatment for rotator cuff tears. Due to the fact that only three studies were included in this analysis and the overall sample group of patients was small, additional studies are now needed to investigate this matter further. Before these studies are completed, a conservative treatment that includes physical therapy should be regarded as the best possible option for rotator cuff tears. This is based on the findings of this analysis and the fact that surgery is more expensive and associated with more complications than conservative treatment.

-As reported in the July ’16 issue of Disability and Rehabilitation

Using desks with a standing capability may increase work productivity
July 28, 2017

Sitting for too much of the day associated with negative health effects

Most Americans spend a great deal of their time each day&#8211approximately 8-9 hours&#8211sitting. This is primarily due to the fact that the majority of employed individuals work desk jobs that require a seated position. This type of lifestyle, in which a person sits for large portions of the day, is called sedentary behavior. Numerous studies have shown that sedentary behavior is associated with several negative effects on health, including obesity, heart disease, diabetes, and cancer. This may even be true for individuals who are physically active and meet the recommended guidelines. One particular group of workers who are affected by sedentary behavior is call center operators, who spend about 90-95% of their work shift in their seats. As a result of the recognized dangers of sitting, the use of standing desks has been introduced to some offices. Standing desks have been received well and have been found to reduce discomfort and improve work efficiency. For this reason, a new study was conducted to determine the effects of stand-capable workstations on work productivity in a call-center over six months. A stand-capable workstation means that the height of the desks could be adjusted.

Two groups of workers are compared over six months

A total of 167 employees in a call center who provided health and clinical advising over the phone served as the study group. These employees were split into two groups: one group of 74 workers would use stand-capable desks, while the other 93 were to use standard seated desks. The stand-capable desks used were either sit-to-stand or stand-biased. Sit-to-stand desks could switch from a sitting mode to a standing mode, while the stand-biased desks could be adjusted to different heights, and when low enough, the user could sit at them on a high stool. These two groups then used their desks for six months, and data on their work productivity was collected from them on a daily basis.

Workers with stand-capable desks sit less and are more productive

Results showed that workers using the stand-capable desks were more productive than those who were using the standard seated desks. On average, the stand-capable workers had 0.5 more successful calls per hour than seated workers over the entire span of the study, especially the final five months. The productivity of the stand-capable workers increased from about 23% in the first month to 53% over the next six months, and these workers were found to be about 45% more productive overall than seated workers. Although it’s not entirely clear why the stand-capable desks led to an increase in worker productivity, it’s possible that it may be due to less body discomfort, better functioning or a combination of these factors. Other studies have identified these positive effects of stand-capable desks, and additional studies will help to better understand it. On the whole, this current study shows that using a stand-capable desk can increase the productivity of workers by getting them to sit for less of the day. Future research should continue to look into this matter further while other efforts push to introduce these types of desks in more workplaces.

-As reported in the May ’16 issue of Physical Therapy

Physical therapists may be an alternative to seeing a doctor first
July 20, 2017

Aging population will increase the number of patients doctors have to see

A large percentage of the population throughout the world is getting older. In the United Kingdom, the current percentage of the population over the age of 65 is 17%. This has grown from 15% in 1985 and is predicted to rise to 23% by 2035. Similar changes are also occurring here in the U.S. As a result of this increase in the elderly population, there will also be an increase in the number of health conditions that are related to old age. In particular, arthritis and painful conditions that affect the back, shoulders, and knees (musculoskeletal conditions) are all expected to rise. As it stands, most of these patients with musculoskeletal conditions go to see their general practitioner for treatment or a referral to another doctor. But as the population continues to age, it will become difficult–if not impossible–for general practitioners to handle the amount of patients seeking treatment.

Why physical therapy may be part of the solution

For this reason, something needs to be done to ease the load of patients seen by general practitioners. One possible solution is to have patients see a physical therapist for any musculoskeletal conditions first, instead of their general practitioner. Physical therapists typically see patients with these conditions and are well-equipped to diagnose them, treat them and/or refer patients elsewhere. Although some research has been conducted on this topic, additional evidence is needed to support this type of approach to treatment. Therefore, a study was conducted to evaluate if having patients see a physical therapist first for musculoskeletal conditions was safe and effective and if patients were satisfied with the treatment they received.

Patients from two physical therapy practices are evaluated

Two experienced physical therapists were placed at two general medical practices–one in the inner city and one at a university–to provide care for patients. When patients called to make an appointment for issues related to a musculoskeletal condition, they were given the option of seeing the physical therapist as an alternative to the general practitioner. Patients who went with this option were given one or two 20-minute appointments with the physical therapist, which was meant to be as similar to an appointment with a general practitioner as possible. During these appointments, patients were screened for other conditions and offered advice on how to deal with their pain, mainly with exercise and lifestyle changes. If it was determined that a patient needed ongoing physical therapy care, he or she was referred to the full-time physical therapist at their second appointment. All patients were given a questionnaire and assessed for measures like pain and function at their first appointment, and then again one and six months later.

Physical therapy first is safe, effective and less expensive

Results from this study showed that seeing a physical therapist instead of a general practitioner for a musculoskeletal condition was safe, as no patients experienced any negative effects from the treatment. It was also effective, as the majority of patients were found to improve their condition at one and six months later. In addition, 70% of patients who saw a physical therapist first reported that they were completely satisfied with the treatment they received. Finally, the physical therapy-first approach was found to be significantly less expensive than seeing a general practitioner first. Together, these findings show that visiting physical therapists for musculoskeletal conditions is both safe and effective, and less expensive than general practitioners. Considering the fact that up to 30% of complaints a general practitioner sees are related to musculoskeletal conditions, this shows that physical therapy may very well serve as an alternative for patients. More research is needed to investigate this matter in greater detail and confirm these findings, but this study provides hope for both general practitioners and patients alike to address the aging population issue. Patients may, therefore, consider making an appointment with a physical therapist rather than their general practitioner the next time they experience a musculoskeletal condition.

-As reported in the June ’16 issue of Physical Therapy

Patients who see physical therapists spend less time and money
July 14, 2017

Physical therapists are one of the main providers of care for low back pain patients

It’s estimated that about 84% of the population will experience at least one episode of low back pain at some point in their lifetime. Although most cases of low back pain will improve completely within 2-4 weeks, approximately 25% of individuals will go on to have continual episodes of pain and long-term problems. There are several different types of medical professionals that are involved in treating low back pain, but physical therapists are one of the main providers of treatment. When it comes to treating these patients, there is a current set of clinical practice guidelines that have been developed by experts based on the best available research. Though all physical therapists are supposed to be following these guidelines in order to provide the best possible treatment, recent statistics say that only about 30% are actually doing so. Whether or not physical therapists follow these guidelines may have an effect on how much treatment patients have, and how much they spend as a result. Considering the fact that no study has investigated this topic yet, a powerful study called a systematic review was conducted to determine what sort of impact these guidelines have on how patients utilize their healthcare.

Four studies fit the necessary criteria

Researchers searched through four major medical databases for studies on the use of physical therapy for low back pain. They only accepted higher-quality studies that recorded how much patients spent on their treatment and how much care they received overall. This search led to a total of four studies that fit the necessary criteria and were used in this systematic review. The findings of each study were analyzed and compared to one another, and the quality of all studies was also evaluated.

Patients use less overall healthcare when guidelines are followed

The findings of these four studies showed that when physical therapists gave treatment that was in line with current guidelines, patients had less healthcare and spent less overall on their care than those who did not. This was found to be the case due to fewer physical therapy visits, shorter duration of treatment sessions, fewer prescription medications, fewer visits to the doctor and less use of injections and advanced imaging like MRIs. Overall, this saved patients between $300 and $1,300 on the care they received for low back pain. Out of a maximum score of 26 for quality, all studies scored between 19-21, which shows that these findings were based on high-quality studies.

There are a number of reasons some physical therapists do not adhere to current guidelines when treating patients with low back pain, but one point seems clear: those that do save their patients money and time. Patients with low back pain should, therefore, check to see if a physical therapist follows the current clinical practice guidelines for low back pain before making any treatment decisions.

-As reported in the June ’16 issue of Physical Therapy

Patients who have PT after shoulder surgery recover quicker
July 6, 2017

Surgery is only considered after other treatments fail

Subacromial impingement syndrome (SIS) is a painful condition in which tendons or a fluid-filled sac called the bursa in the shoulder become compressed, or impinged, by bones in that region. It’s the biggest cause of shoulder pain and is the most common disorder that affects the upper extremities (shoulders, arms, and hands). Patients with SIS are usually managed with of a number of nonsurgical treatments, including rest, injections and physical therapy. In most cases, surgery is only considered for patients that do not respond to these nonsurgical treatments and fail to improve. After surgery, physical therapy is again part of the typical treatment plan to help patients regain the function of their shoulders. Although this approach is commonly used, there is no consensus about the most appropriate strategy to use, and little is known about the effectiveness of different types of exercise programs. It’s also possible that patients who have trouble returning to normal activities may require additional efforts to help in their recovery. For this reason, a highly respected type of study called a randomized-controlled trial (RCT) was conducted on the topic. In this RCT, patients with SIS who had surgery were randomly assigned to two different treatment groups to determine which was the most effective for helping them recover.

Patients are given either physical therapy or usual care

Patients with SIS who had a surgical procedure called arthroscopic subacromial decompression—in which a tiny scope is used to release pressure in the area—were recruited for the study between 8-12 weeks after surgery. A total of 126 patients fit the necessary criteria and were randomly placed into either the physical therapy group or the usual care group. Patients in the physical therapy group followed a program that consisted of a combination of both supervised training sessions and home-exercise training. They received between 8-15 training sessions during the first eight weeks. Over the next four weeks, the frequency of these sessions varied depending on how patients responded, and they were told to perform their home exercises more regularly. Sessions lasted up to one hour each and consisted of aerobic exercise on a stationary bicycle, manual therapy performed by the physical therapist and seven exercises that specifically targeted the shoulder. Patients were also instructed to become physically active at a moderate or high intensity for at least 30 minutes three times a week. Patients in the usual care group did not receive any specific treatments but were told to continue the treatments recommended by the hospital. All patients were assessed before being assigned to their groups, and then again three and 12 months later for a variety of outcomes, including strength, range of motion and quality of life.

Following a course of physical therapy should be the norm after surgery

Results showed that at 12 months, patients in the physical therapy group improved significantly more than those that received usual care. This was found to be the case due to better scores on various questionnaires that showed the patients who had physical therapy had better shoulder function and less fear about their condition than the other group. They were also found to be more physically active and had a better overall impression of the changes they experienced from treatment. This RCT, which is the largest study that’s ever been performed on the topic, clearly shows that physical therapy leads to numerous improvements for patients with SIS after having surgery. Based on this, physical therapy should be considered a necessary component of recovery following surgery, and it’s recommended that a treatment program similar to the one used here is followed to ensure positive results.

-As reported in the June ’16 issue of Physical Therapy

Getting athletes back to sports without surgery
June 29, 2017

Many athletes with back condition decide to have surgery

Low back pain is a common problem for many competitive athletes, and if it’s severe, it can threaten an athlete’s career. There are many possible causes of low back pain, but a herniated disc is often responsible in this population, as athletes are more likely to experience this injury than the general population. A herniated disc relates to the intervertebral discs that rest between the bones (vertebrae) of the spine. It occurs when a jelly-like substance in the center of the disc pushes out through a crack in the tougher exterior, and it can cause pain, weakness and tingling or numbness. When this type of injury occurs in athletes, they are sometimes able to choose between having it treated with surgery or non-surgically (conservative treatment). Although surgery was once commonly recommended for both athletes and non-athletes with herniated discs, it’s no longer clear which of the two treatments is better. In particular, it’s important to measure the return to sports rate for athletes in order to determine which treatment helps them get back to their sport faster. Since evidence on this topic is limited, a powerful study called a systematic review was conducted. The systematic review identified all the relevant medical literature on surgery versus conservative treatment for herniated discs. This review was followed by a meta-analysis, which analyzes each of the studies found in the systematic review in detail in order to identify trends.

Injured athletes from various professional sports are analyzed

To conduct the systematic review, six major medical databases were searched for studies that compared patients with a herniated disc who had surgery to those who were treated conservatively. In particular, each study had to include information on the return to sports rate for athletes after these treatments. Out of the 260 studies that were screened, 14 fit the necessary criteria and were accepted. These 14 studies contained information on 964 athletes from the NBA, NFL, MLB, NHL and many amateur sports leagues with herniated discs that were treated either surgically or conservatively. The findings of these studies were then analyzed to see which of the two approaches helped athletes return to their sport faster.

No major differences found between surgery and conservative treatment

Overall, researchers found no significant differences between the two groups regarding return to sports. Some athletes returned to their sport faster after having surgery, while others returned faster with conservative treatment, and the rates between the two were very similar. This similarity was also found for long-term outcomes: the number of athletes that returned to their prior level of function in sports was close between groups, while baseball players treated with surgery had significantly shorter careers than those treated conservatively. In some cases, athletes who did not receive any treatment actually had similar outcomes to those who had surgery. These findings suggest that for athletes with a herniated disc, having surgery may not always be the best option. Not only is surgery more expensive and more likely to lead to complications, but according to this study, it may lead to similar-or worse-results than conservative treatment. For this reason, unless there are other major problems, an athlete with a herniated disc should consider being treated conservatively with physical therapy first. If a course of conservative treatment fails, then an athlete should consider having surgery, and they should be informed of the risks involved and the return to sports rates before doing so.

-As reported in the October ’15 issue of the British Journal of Sports Medicine

Exercise & therapy help with pain and improve hip arthritis
June 22, 2017

Updated review is needed to determine if treatments should be used

Hip osteoarthritis is a condition in which cartilage that surrounds and protects the hip joint gradually wears away. This causes bones to rub against one another and leads to pain and disability in patients with the condition. When it comes to non-surgical (conservative) treatment for hip osteoarthritis, exercise therapy and manual therapy are often recommended first. Exercise therapy includes aerobic exercise and a number of other different exercises designed to improve strength and range of motion, or flexibility of the hip. Manual therapy is a hands-on treatment performed by physical therapists that consists of various mobilizations and manipulations to the joint. Its goal is to improve the mobility of the hip and the surrounding area, which can reduce pain and improve physical function. Although there are studies that support exercise therapy as an effective treatment for hip osteoarthritis, there is little research on the effectiveness of manual therapy for this condition, either when used alone or when combined with exercise therapy. For this reason, a powerful study called a systematic review was conducted, which gathered all the relevant studies on exercise therapy and manual therapy for hip osteoarthritis. This was followed by a meta-analysis, which analyzes each of the studies found in the systematic review with the goal of identifying important trends.

Seven studies are accepted for the review

To find data for the review, 10 major medical databases were searched for studies on the use of exercise therapy, manual therapy or both for hip osteoarthritis. Of the 372 studies that were screened, a total of seven met the necessary criteria and were included in the review. These studies contained information on 886 patients, and they investigated the effects of the treatments on pain, physical function and quality of life. Physical therapists delivered the treatments in all studies except for one, and the nature and frequency of these treatments varied in each of the included studies. Once collected, all studies were then analyzed to determine which of these treatments was most effective for hip osteoarthritis.

Both therapies are effective on their own, but not in combination

Results from the meta-analysis revealed that both exercise therapy and manual therapy are effective for reducing pain and improving physical function in patients with hip osteoarthritis. There was also low-quality evidence that combining exercise therapy and manual therapy can lead to benefits as well, but these benefits were only found to last for a short amount of time. The reason for this may be that patients who had both treatments did not spend as much time on each therapy than those who received only one. Nonetheless, this systematic review and meta-analysis show that both exercise therapy and manual therapy can be helpful for treating hip osteoarthritis. Therefore, patients with this condition should strongly consider seeing a physical therapist for a treatment program that consists of these therapies in order to alleviate their pain and improve their physical function.

-As reported in the December ’15 issue of Clinical Rehabilitation

Seeing a PT may lead to lower costs and less medical treatment
June 7, 2017

Spinal disorders are very common and expensive

Musculoskeletal disorders are injuries or pain in structures like ligaments, joints, and tendons throughout the body. They are one of the biggest health care problems affecting middle-aged Americans because they are extremely prevalent and expensive to treat. Of all musculoskeletal disorders, spinal disorders like low back pain account for the majority of costs and disabilities that people experience. This is mainly due to an increase in imaging studies like MRIs and CT scans, steroid injections, and spinal surgeries. As a result, there is a need for a better approach to reduce costs and improve the outcomes for patients.

Doctors may not refer patients to physical therapy for up to six weeks

Physical therapy is commonly prescribed as an effective treatment for patients with spinal disorders and other musculoskeletal disorders. The timing of when a patient is referred to physical therapy, and when it begins, can have a significant effect on the results they experience and the costs of treatment. Currently, guidelines recommend that doctors should delay referring patients with back pain to physical therapy for up to six weeks. Despite this, some studies suggest that starting physical therapy earlier-within 1-4 weeks-could lead to better outcomes and reduce the risk for developing long-lasting (chronic) pain and disability. Since these two approaches conflict with each other, more research is needed to determine how long a patient should wait before seeing a physical therapist. Therefore, a systematic review was conducted, which is a high-quality, comprehensive review on all the available studies on the timing of physical therapy for musculoskeletal disorders.

A total of 14 studies are used for the review

Researchers conducting the review searched through four major medical databases for studies that were relevant to the topic. In order to be selected for the systematic review, each study had to include data on physical therapy used for a musculoskeletal disorder, with one group using physical therapy early and the other using it later. A total of 3,135 studies were screened, and 14 of these fit the necessary criteria and were used for the review. These studies ranged in size and in quality, with the smallest study including 280 participants and the largest including 431,195 participants. The findings of all of these studies were then analyzed with the goal of determining if it was more beneficial to begin physical therapy earlier.

Some patients may benefit from seeing a physical therapist early

Although the review was supposed to cover a number of different musculoskeletal disorders, all the studies that were selected focused on spinal pain. Overall, there was evidence that starting physical therapy early (within four weeks) was associated with lower costs for the patient when compared to delaying treatment. This was likely due to the fact that fewer tests and interventions- like injections and surgery-were used when patients began treatment sooner. Those types of interventions may be recommended when patients hold off on treatment and see a doctor before a physical therapist. Unfortunately, the quality of the studies used in this systematic review was not very high, and additional studies are needed to investigate this topic in greater detail. Nonetheless, this review suggests that there is no risk of starting physical therapy within four weeks after low back pain is first noticed, and it may actually save patients money. Patients with low back pain and other spinal disorders should therefore consider seeing a physical therapist sooner rather than later for their condition.

-As reported in the February ’16 issue of the Journal of Orthopaedic & Sports Physical Therapy

Hands-on therapy combined with exercise has benefits for neck pain
May 25, 2017

Exercise is considered an important part of treatment

When there is no specific cause that leads to the development of neck pain, it’s referred to as nonspecific. Nonspecific neck pain is a very common condition that affects between 30-50% of the general population. This type of pain usually has a negative effect on daily life and can cause patients to seek out treatments that may become expensive over time. It is therefore important that the treatment these patients receive is effective and improves their physical functioning and quality of life. Exercise is one intervention that is strongly supported by research and considered an important part of any rehabilitation program. In particular, exercises that strengthen, or stabilize certain parts of the spine can be helpful for neck pain. In addition, a hands-on form of therapy called manual therapy may also be useful for reducing pain and increasing flexibility and function. Manual therapy includes two different approaches called manipulation and mobilization, and research has shown that these therapies can improve neck pain. On the other hand, there is a lack of studies that have looked into the combination of manual therapy and stabilization exercises for nonspecific neck pain. For this reason, a study called a randomized-controlled trial (RCT) was conducted. An RCT is a powerful, high-quality study that randomly assigns patients to different treatment groups in order to determine which of these treatments is more effective for neck pain.

Over 100 patients accepted and completed the study

Patients diagnosed with nonspecific neck pain for at least three months were recruited and screened to determine if they were eligible for this RCT. Out of the 116 patients assessed, 102 fit the necessary criteria and completed the study. Each patient was randomly assigned to one of two groups: the stabilization exercises only group or the manual therapy with stabilization exercises group. Patients in the stabilization exercises only group went through a program of three exercise sessions per week for four weeks. Each session lasted one hour and consisted of exercises that were intended to strengthen and stabilize the muscles surrounding the neck and shoulder blades. Before each session, the physical therapist would also provide education on how to achieve and maintain proper posture to reduce strain on the neck. Patients in the other group received the same treatments, as well as a series of mobilizations to the neck and shoulder blade region. These applications lasted for 15-20 minutes and were also performed three times a week for four weeks. All patients were evaluated for disability, neck pain intensity, quality of life and neck range of motion, or flexibility, before and immediately after the treatments.

Combining the two treatments leads to the greatest benefits

After four weeks, it was found that stabilization exercises and manual therapy led to greater improvements in disability, pain intensity at night, neck range of motion and quality of life than stabilization exercises only. This shows that while stabilization exercises may be beneficial on their own, combining them with manual therapy appears to lead to even better results. Since this RCT only evaluated these patients before the treatments and after they concluded four weeks later, it’s difficult to determine if these treatments will also lead to long-term benefits. Additional studies are needed to investigate this matter in greater detail. Nonetheless, this RCT supports the use of stabilization exercises and manual therapy for treating nonspecific neck pain, and patients with this condition are encouraged to seek out physical therapy that can deliver these effective treatments in order to help them improve.

-As reported in the February ’16 issue of the Journal of Orthopaedic & Sports Physical Therapy

Physical therapy more effective than advice for low back pain
May 18, 2017

Advanced treatments are needed since condition is complex

Low back pain (LBP) is one of the most common medical conditions in the general population, and it serves as a major cause for disability in people who suffer from it. LBP is also extremely expensive, and most of the costs associated with it are due to injuries that last longer than six weeks, which can prevent patients from going to work normally. Unfortunately, up to 71% of people who experience LBP once will still have symptoms one year later. This shows just how important it is to create treatments that are effective for people after experiencing the first signs of LBP. Advice on how to avoid pain in daily life is considered an important part of treatment for these patients, but more is needed. LBP is a complex disorder that can occur from many different causes, and more advanced treatments are therefore necessary.

Physical therapy that is personalized, or individualized to each patient, is one such treatment that may be effective for LBP. Individualized physical therapy takes into account various factors that may be responsible for the patient’s pain, and then addresses these factors with specific treatments to help the patient improve. Though there have been studies on individualized physical therapy, no high-quality studies have evaluated it combined with advice for LBP. Therefore, a randomized-controlled trial (RCT) was conducted on individualized physical therapy in addition to advice for LBP patients. RCTs are the most powerful type of individual study that can be performed.

Participants are randomly divided into two treatment groups

Volunteers who had LBP for at least six weeks but no more than six months were evaluated to determine if they were eligible for the RCT. Out of the 2,038 volunteers who were evaluated, 300 fit the criteria and were accepted. These 300 participants were randomly assigned to one of two groups: the individualized physical therapy with advice group or the advice-only group. Participants in the first group attended 10 sessions that lasted for 30 minutes over 10 weeks of treatment. Each patient in this group was then given a specific, individualized treatment program based on their condition. Though each program was different, they all consisted of various exercises to address the patient’s pain and problems functioning normally. Participants in the advice-only group attended two 30-minute sessions in which a physical therapist explained the nature of their pain, reassured them that they would improve, and gave them advice on how to remain active without making their pain worse. Participants in the first group also received very similar advice on their condition. All patients were assessed using questionnaires on their pain and activity levels before treatment and then again five, 10, 26 and 52 weeks later.

Combination of two treatments better than advice alone

At the end of 52 weeks, results from the RCT showed that both groups actually improved over time according to the questionnaires. The individualized physical therapy with advice group, however, experienced greater improvements overall. The combination group showed significantly higher activity levels at 10, 26 and 52 weeks, as well as significantly less pain at 5, 10 and 26 weeks. These findings show that while both treatments were effective for patients with LBP, combining individualized physical therapy with advice is even more helpful for patients. Most importantly, this shows that the improvements patients make after 10 weeks of treatment can last for up to one year. It appears that patients with LBP will, therefore, benefit from individualized physical therapy that addresses their problem on personal basis along with advice that can help guide patients further and encourage them along the way.

-As reported in the October ’15 issue of the British Journal of Sports Medicine