Early physical therapy might help ease lower back pain

Starting physical therapy right after lower back pain begins may provide relief sooner compared to doing nothing, but makes little difference over the long term, a U.S. study suggests.

Researchers followed more than 200 patients with recent onset of lower back pain for a year, randomly assigning them to receive either physical therapy or no treatment for four weeks at the start of the study.

Even though the physical therapy group reported more improvement in disability after three months than the other people in the study, there wasn't a significant difference between the groups after one year.

"There are no quick fixes or `magic bullets' for treating back pain," said lead study author Julie Fritz, associate dean for research at the College of Health at the University of Utah in Salt Lake City.

"The take-home message for patients is that physical therapy may help somewhat in promoting a more rapid return to function following an episode of low back pain," Fritz added by email.

Back pain accounts for 2 to 5 percent of all doctor visits in the U.S. and about $86 billion in healthcare costs, Fritz and colleagues note in the Journal of the American Medical Association.

Current physician practice guidelines recommend delaying physical therapy or other specialists for a few weeks to see if back pain subsides on its own without treatment, they write.

For the current study, researchers wanted to see if patients might benefit from starting physical therapy sooner.

The study team assigned 108 people to receive early physical therapy, starting soon after symptoms began, and randomly selected another 112 people to stick with usual care.

The participants assigned to usual care typically saw a primary care provider, though a few people had massage therapy or visited a spinal specialist or chiropractor during the study.

Early physical therapy resulted in a statistically significant improvement in disability relative to usual care, but the magnitude of the difference was modest and didn't appear big enough to be clinically important at the individual patient level, the study found.

One shortcoming of the study is that more patients dropped out from the usual care group than the physical therapy group, the authors acknowledge.

Another problem with usual care is that it's essentially not any care at all, noted Dr. Ryan Petering, a sports medicine researcher at Oregon Health and Sciences University in Portland who wasn't involved in the study.

To get a more complete picture of the benefits of physical therapy, it would be helpful to compare people who got this intervention to another group of people who got instructions on how to do exercises on their own at home, Petering said by email.

"For many patients, dealing with chronic back pain (the category you'd be in if still experiencing it at one year) requires maintenance therapy - not exclusively with a therapist but doing a home exercise program, possibly one given by to you by a therapist," Petering said.

It's also possible that providing physical therapy over a longer period of time might have produced additional benefits, but it's hard to determine that from the current study, said Steven George, a physical therapy researcher at the University of Florida who wasn't involved in the study.

Even if the benefit is limited to the first three months after the onset of pain, however, patients may think physical therapy is worth the effort, George said by email.

"If patients knew that their symptom relief is not going to be complete, but it has a chance of placing them at a better recovery trajectory earlier, then patients would likely be in favor," George said.