The Study: Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review.
a. Chronic low back pain affects the quality of life of people throughout the world.
b. The study examined the effectiveness of classical physical therapy treatments for non-specific lower back pain.
c. Only approximately 15% of patients who suffer from low back pain are diagnosed with a specific cause for the condition.
d. The authors note there are many studies showing that absolute rest is not an efficient treatment for low back pain.
e. Drug therapy shows no evidence of medium or long term effectiveness but is associated with well known complications.
f. Thermotherapy, transcutaneous electrical nerve stimulation and interferential stream have been shown to be ineffective.
g. Manual therapies have been shown to have “a positive effect on effect on both pain and motor activity.”
h. They reviewed randomized controlled trials published in the English language.
i. When they looked at the studies they found three for inclusion regarding manipulation. One showed results in the short term the second showed that once the treatments were stopped then there was no medium of long term positive results and the third showed neither short nor long term benefit.
j. In a study “soothing” massage and massage focused on “releasing muscular tension” there was reduction “immediately after the conclusion of the study at 10 weeks after intervention, both in pain relief and an increase of functional capacity” but was not maintained over the next 26 and 52 weeks.
k. As to exercise, one study showed neither Back School nor McKenzie exercises to be effective for pain. Another study showed “effectiveness of the postural global reduction” by exercise and “a reduction in pain that lasted until three months after the study completion”. A third study determined that there was neither short nor long term pain relief with either supervised or home exercise.
l. “Based on the acquired results, it seems that the application of classical physiotherapy proposals yields results that are not very effective in the management of chronic non-specific low back pain.”
The studies seem to support the conclusion that none of these treatments provide a “cure” for non-specific chronic low back pain.
Actually I don’t think this is too amazing to seasoned clinicians. There certainly doesn’t seem to be any magic bullet. If you read this study carefully, manipulation does help in the short term and if you think about it this helps make a case for what is called “maintenance care. I did note that making a structural change in global posture with exercise made a difference and certainly deserves a closer look with more studies.
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Cuenca-Martinez F, Cortes-Amador S, Espi-Lopez GV. Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res. 2018 Mar 20;21(1):16-22. doi: 10.1298/ptr.E9937. eCollection 2018.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/30050749