Active Rehabilitation of Low Back Pain

Over the last few years, a consensus has emerged in the medical literature that active treatment of back pain is more successful than passive approaches, such as bed rest and medications.

This is yet another study that compares the two different approaches. Active rehabilitation in this case was defined as, "educational, psychological, and social components along with therapeutic exercises;" the regimen included 24 (11/2 hour) exercise sessions over 12 weeks, with encouragement to perform at home. The purpose of the plan was to improve mobility and teach coordination of the spine. The passive treatment was a non-exercise-based controlled treatment designed for minor efficacy, and included thermal therapy and massage once a week for a month. 30 LBP patients were enrolled in the active group, and 24 in the passive. The authors assessed patient's pain, self-experienced disability, and lumbar fatigability. Subjects were evaluated immediately before and after treatment, at six months, and one year after treatment.

At the baseline, pain intensity and disability was the same in both groups. The self-reports indicated moderate to severe intensity, but minor disability caused by low back pain. At follow-up assessment reductions in back pain intensity and disability were larger in the active group than in the passive control.
An aspect of this study focused on lumbar endurance. The authors utilized a complex test, which provided objective measure of endurance both before and after treatment. They found:

"Active rehabilitation was effective in improving objectively assessed lumbar paraspinal muscle endurance, at least in the short term. However, the change tended to diminish during the follow-up, one year after the rehabilitation."

Furthermore, the results also showed that improved lumbar endurance correlated to lessened intensity. This finding was significant since it allowed the practitioners to monitor patient progress objectively and individually during the active treatment program.

Kankaanpaa M, Taimela S, Airaksinen O, Hanninen O. The efficacy of active rehabilitation in chronic low back pain. Spine 1999;24(10):1034-1042.