What is the role of physical therapies in the management of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Physical therapy for the spine can be divided into passive and active therapies. Passive therapies are those that physiotherapists apply, such as ultrasound, electric muscle stimulation, traction, heat and ice, and manual therapy.

Passive modalities are most appropriate when used for short-term treatment of an acute back injury or an exacerbation of cLBP. When possible, self-administration of appropriate modalities by the patient is frequently advocated, especially for those with cLBP. Corsets and braces are long-used adjuncts to treatment, though their efficacy has not been demonstrated in methodologically sound studies. [273] In a mixed population of patients with back pain of varying duration, no difference could be demonstrated between groups receiving lumbar supports versus control groups receiving other types of treatment. [59] Eighty-nine percent of patients who use a brace have reported benefiting from this therapy. The primary mechanisms of action are unclear and probably differ by the type of brace and the patient's morphology, pathoanatomy, and spinal activities. Also, a rigid orthosis was determined to be more effective than a simple support aid.

Traction is a long-endured medical prescription for LBP and is incorporated into a variety of methods to treat conditions of the spine. Acute pain or an exacerbation of cLBP is the usual recommended indication. When traction is administered to the lumbar spine, at least 60% of the patient's body weight is necessary to produce dimensional changes in the lumbar disk, but there is no scientific support to suggest that this maneuver reduces a disk herniation. A recent review did not show improvement in either pain or function for subjects receiving traction compared with controls. [273, 106]

The effectiveness of transcutaneous electrical nerve stimulation (TENS) is also unclear. [273, 106] A Cochrane review found conflicting evidence regarding the efficacy of TENS for cLBP in 2 randomized trials. [274]


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