Physical Therapists Put Treatment to the Test
Physical therapists often treat patients with acute low back pain (LBP). Yet no one really knows what works best for this problem. According to the Agency for Health Care Policy and Research (AHCPR), watchful waiting is best in the first four to six weeks.

Using these guidelines, doctors and therapists give patients advice and assurance, but symptoms are not treated. Patients are told to stay as active as possible. Low-impact aerobics are okay but nothing stronger until after four weeks.

A physical therapist uses a new model of treatment for acute low back pain. Patients are classified by their symptoms. This guides the type of treatment that is given. This is a classification-based model. In contrast, treatment that is based on clinical practice guidelines (like those given by the AHCPR) is more like following a recipe. The treatment doesn't vary over time or according to patient response.

The authors report greater patient satisfaction after four weeks using the classification-based method. Patients are also more likely to return to full-duty work. After one year, this group showed a trend toward improved function.

The best timing and methods of treatment for patients with acute LBP remain unknown. Physical therapists are comparing current standards with treatments that target individual patients with specific symptoms. More research is needed to find the right exercise program for the first month after back pain begins.
Julie M. Fritz, PhD, PT, ATC, et al. Comparison of Classification-Based Physical Therapy with Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain. In Spine. July 1, 2003. Vol. 28. No. 13. Pp. 1363-1372.