FPIN's Clinical Inquiries

Physical Therapy for Low Back Pain


Am Fam Physician. 2018 Jul 15;98(2):115-116.

Clinical Question

Is early physical therapy an effective treatment for acute low back pain?

Evidence-Based Answer

There is some evidence that early physical therapy may decrease posttreatment health care utilization for low back pain. (Strength of Recommendation [SOR]: B, based on a single randomized controlled trial [RCT].) Physical therapy started within 24 hours of clinical presentation provides only minimal improvements in pain (one point out of 11), patient satisfaction (two points out of 21), and mental health (five points out of 101) within one week, and even these improvements are lost at one, three, and six months. (SOR: B, based on a single RCT.) Physical therapy started within 48 to 72 hours of presentation does not result in clinically significant improvements in pain or disability at one to four weeks. (SOR: B, based on RCTs and a systematic review of RCTs.)

Evidence Summary

A 2008 RCT of 110 adults presenting to the emergency department for acute nonspecific low back pain evaluated the effectiveness of emergency department–based physical therapy initiated within 24 hours of presentation.1 Treatment consisted of education, reassurance, pain management, mobility training, interferential therapy (electric current from 70 to 130 Hz with pulse duration of 130 μs and swing pattern of six seconds), walking training, and walking aids. The control group received only walking training and walking aids. Both groups started outpatient physical therapy within one week of discharge. Patient satisfaction was slightly better in the treatment group compared with the control group at discharge (mean difference [MD] = 2.1 points on a 21-point scale; 97.5% confidence interval [CI], 1.2 to 2.9). Mental health scores were also slightly higher in the treatment group at discharge (MD = 5 points on a 101-point scale; 97.5% CI, 0.3 to 9). Pain relief was slightly better in the treatment group within one week after discharge (MD = −0.9 points on an 11-point scale; 97.5% CI, −1.6

Author disclosure: No relevant financial affiliations.

Address correspondence to Corey Lyon, DO, at corey.lyon@ucdenver.edu. Reprints are not available from the authors.


show all references

1. Lau PM, et al. Early physiotherapy intervention in an accident and emergency department reduces pain and improves satisfaction for patients with acute low back pain. Aust J Physiother. 2008;54(4):243–249....

2. Fritz JM, et al. Early physical therapy vs usual care in patients with recent-onset low back pain. JAMA. 2015;314(14):1459–1467.

3. Machado LA, et al. The effectiveness of the McKenzie method in addition to first-line care for acute low back pain. BMC Med. 2010;8:10.

4. Machado LA, et al. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine (Phila Pa 1976). 2006;31(9):E254–E262.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content

More in Pubmed


Jul 15, 2019

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article