Many of us will experience lower back pain at some point in our lives and when it does happen, no doubt we will all get advice from people about what to do- everything from rest to exercise, from back braces to manipulation.

So what treatments actually work?

The best way to answer this is to have a look at current scientific evidence (yes, I must admit that scientific evidence is by no means perfect and is always being updated, but it does provide us with some good information about what works most of the time, for most people).

To begin with, your back pain should always be assessed by a qualified healthcare professional (e.g. GP, physiotherapist or chiropractor) to rule out any serious injuries or disease processes, and to get advice about how it should be managed (there is excellent evidence for this!).

Here is how current popular treatments stack up under clinical trials and systematic reviews:

1.Advice to stay active
For acute low back pain, there is significant evidence that staying active and maintaining normal activity levels leads to quicker recovery time and less time off work.

2.Bed rest
There is no evidence to suggest that bed rest improves outcomes for people with acute or chronic lower back pain, and in fact it is more likely to cause harm from muscle deconditioning, weakness and stiffness.

3.Exercise Therapy (stretches, strength exercises etc.)
Believe it or not, there is still no evidence to suggest that structured exercises work well for treating acute low back pain despite being a regular part of treatment. Therefore if you are doing some basic exercises for acute back pain and it’s working, then fantastic, keep doing them. If they aren’t working, then stop!

There is very good evidence on the other hand, that core strengthening and general strength and fitness exercise programs are good for treating people with chronic back pain. The evidence also suggests that results are significantly better when these programs are supervised. Some specific exercises can reduce the chances of lo back pain from recurring in the future as well.

4.Spinal Manipulative Therapy
This is anything from gentle mobilising of the spine to high velocity manipulations or “cracking” the spine. It is one of the most common ways that physiotherapists, chiropractors and osteopaths treat back pain. It has been shown to be an effective way of decreasing pain in acute and sub acute back pain, however, to the surprise of many it has recently been shown to be no more beneficial for acute lower back pain than good advice and paracetamol.

It has also surprised a few recently to find that a study has shown some benefit of spinal manipulative therapy for people with chronic back pain. In general, it could be said that spinal manipulative therapy can reduce pain in the short term, but probably doesn’t significantly alter the course of lower back pain.

Despite many studies, there is no significant evidence for acupuncture providing any benefit for acute low back pain. Interestingly, there are many people who are raving fans of acupuncture and current guidelines recommend that, as long a clinical and functional improvement can be demonstrated, acupuncture can be used for treating low back pain.

Massage on its own has been shown to be more effective than relaxation and acupuncture, but less effective than exercise and spinal manipulative therapy. It is best used in combination with other treatments rather than by itself.

7.Tens machines
These are small electronic nerve stimulators that can reduce pain by calming down the pain impulses from the lower back. At one stage patients with chronic lower back pain had them implanted in their backs like a pacemaker for mobile pain relief, but most of the time they are just attached to the skin via stick on electrodes.
There is no evidence however to suggest their use in the treatment of acute or chronic back pain. They have a nice tingling feeling, but there are probably better options for treatment for most people.

Magnets have been shown to be no more effective than placebo treatment and therefore shouldn’t be used as treatment for back pain. Unlike some of the other treatment options that are not supported by hard evidence, I haven’t heard many people praising the effects of magnets for lower back pain.

9.Back supports/corsets/braces
I see many patients at my physiotherapy clinics using back braces for lower back pain. Most studies show that there is no benefit or that there is limited evidence for using back braces compared with no treatment. It is still unclear however – so if it seems there is a benefit to the individual they should continue to use the brace.

Studies show conflicting evidence regarding traction. Some have found there is a benefit and others have found there is not. Therefore, once again, if the individual has tried it and there has been a benefit then it can be used, if not then it should be discontinued. In any case, it probably shouldn’t be the first choice for treatment.

In summary, current evidence for acute back pain suggests that the best treatment involves having your back assessed so that you can get the right advice about how to stay active and manage your pain. If you are in need of further relief some spinal manipulative therapy (mobilisations or manipulations) should be considered.

For chronic back pain, an exercise program involving core strengthening and exercises to improve general fitness is the most effective solution.

Click here for exercises to help prevent lower back pain.

This advice is strictly for simple, non-specific lower back pain, not for back pain caused by serious injuries, fractures, disc bulges, disease processes, sciatica etc. This information is not a substitute for independent professional advice. This information should not be used on its own to diagnose, treat, cure or prevent any injury or disease. The accuracy and completeness of information cannot be guaranteed at the time of reading. Please contact the practice and speak to a qualified professional if you have any specific questions related to this material.