Anyone who has every suffered spinal pain knows there is a broad range of treatments available based on the helpful advice offered by friends and family. Every spine is unique and every problem different, subsequently different strategies work for different people at different stages.

Some techniques work, some don't and some are just plain inappropriate.

As a consumer how do you know? The best way is to look at the scientific research. The Australian Physiotherapy Association. reviewed all of the scientific literature available using strict guidelines supplied by the National Health & Medical Research Committee. Using only the highest quality research (Level I & II) the results of the review will educate consumers and health care professionals on what treatment techniques have sufficient evidence to support their use. Those techniques without sufficient evidence are not necessarily flawed, just currently unsubstantiated.

For more information regarding scientiffically supported treatments we recommend Physiotherapy Choices. For information on inappropriate treatments we recommend Quackwatch.

Low Back Pain

Acute (less than 6 weeks) There is sufficient evidence to support the role of physical therapies in the treatment of acute low back pain. Specifically, there is sufficient evidence to support spinal manipulation, encouraging early activation and normal activity, and McKenzie therapy in the treatment of acute low back pain. Equally, interventions such as the application of heat, shortwave and prolonged bed rest have insufficient evidence to support their effect at present and are therefore not recommended as a first choice for treatment.

Sub-Acute 6 weeks to 6 months)(There is sufficient evidence to support the role of physical therapies in the treatment of sub-acute lower back pain. Interventions with sufficient evidence include manipulative physiotherapy, early activation and reassurance. Such intervention has resulted in less sick leave and better pain relief than traditional medical care.

Chronic (greater than 6 months) There is sufficient evidence to suggest that general exercise is effective in the management of chronic lower back pain. When supervised by physiotherapists the functional outcomes such as reduced absenteeism, faster return to work rates and reduced disability have been supported. Importantly, this achieves the desired functional outcome with cost-effectiveness.

The role of manipulative physiotherapy in the treatment of lower back pain appears to be more efficacious than traditional treatments such as bed rest, analgesics and massage. Specific exercises as prescribed by physiotherapists are also starting to show a reduction in recurrence rate of low back pain as well as less functional disability. Therapies such as traction, electro-physical modalities and massage have insufficient evidence to justify their use as a first choice of treatment in the management of chronic lower back pain.

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