The number of treatments available for back and neck pain exceeds the number of possible problems.  Some techniques work, some don't and some are just plain inappropriate.  But 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 determining appropriate treatments and remedies we recommend www.quackwatch.com.
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 low back pain.  Interventions with sufficient evidence include manipulative physiotherapy, early activation and reassurance.  Such intervention have 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 low 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 low 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 low back pain. 

Treatment

Neck Pain

There is considerable evidence to support the benefits of manipulative physiotherapy in reducing acute and chronic neck pain. Studies in the main have evaluated spinal manipulative therapy in short-term follow-ups. Manipulative therapy comprises passive joint mobilisation and manipulation.  Insufficient studies have undertaken long-term follow-up to allow firm conclusions to be drawn about the long-term efficacy of manipulative therapy for neck pain.  Firm conclusions about efficacy of traction cannot be drawn from Level I evidence at this stage. Of five randomised controlled trial's, two had positive and three negative outcomes.  There is recent Level II evidence to support the use of specific exercise rehabilitation, but no evidence is available on Pilates therapy, Feldenkrais or Alexander techniques.  The evidence available regarding the efficacy of electro-physical agents is limited. Some limited experience is available in support of pulsed electromagnetic therapy, TENS and biofeedback. At present there is no evidence that supports the use of ultrasound, infra-red therapy, or laser therapy. The efficacy of acupuncture has minor support from Level I evidence and moderate support from Level II evidence.  Level II evidence suggests that cervical collars are not useful. There is no support for bed rest.  Limited Level II evidence suggests that multi-modal therapy, combining manipulative therapy, exercise and cognitive-behavioural therapy is effective in the management of neck pain.


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