Low back pain, which is best: Intervention or self-management?

Long term physiotherapy is about self management. Long term physiotherapy is not about being treated, for the patient to go about their daily lives, and not adjusting the reason for their problem. For example: Having low back pain, being treated then going back to work and continue to lift at work with a poor lifting technique. However, is the management for low back pain about self-management alone?

Fritz et al (2015) asked just that in their randomised controlled trial. They compared early physiotherapy intervention versus usual care.

Early physiotherapy intervention incorporated spinal mobilisations, range of motion exercises and trunk strengthening exercises. Massage was not offered in this trial!

Usual care incorporated were given an advice booklet only.

The researchers identified a significant difference in improvement for those with early intervention. However, this was only significant in the short term only (3 months). As time progressed there was no significant difference between groups at the 1 year follow up. Whilst some clinicians may take this as another reason to use hands on physiotherapy for their clients stating they'll get better over time.

Yet, anyone who has been treated for low back pain by me, will know I am an hands on physiotherapist and I see instant gains. There are several arguments here for the use of hands on treatment: Prevent your client becoming chronic 3 months or less is acute. 3 months or more is chronic. It is well known in our profession that treating people with chronic low back pain is far more than just advice and exercise alone. We have to challenge their beliefs, worries and fears. This can take a multi-disciplinary approach including cognitive therapy.

Show your patients that they can get better A lot of people with low back pain fear the worst. They fear harm, they fear damage, they fear something is wring inside them. If you can show them that some mobilisations to their joints or some gentle stretches can show significant differences to their pain, you can reassure patients that you have made them better by pushing hard on their joints, not made them worse. You can show them by moving beyond what they are comfortable with eases their pain. By performing hands on and going through exercises with your client, can demonstrate their effectiveness and therefore likely to increase the compliance of continuing as part of a self-management program. I am a hands on physiotherapist. Some physiotherapists are a hands off and advice only practitioner. I believe that hands on physiotherapy can get quicker results and prevent someone having chronic low back pain. Demonstrating exercises with my client allows me to demonstrate that I know what feeling they will feel and I can then reassure them that this is what a normal feeling is. If you or anyone you know suffers from low back conditions and would like help and advice, then contact us, or follow us on facebook.com/mikestampphysiotherapy