Terry O'Brien General Manager of Back Trouble UK says that, "Physical therapy has a significant benefit for mechanical back pain. Studies show that, for patients presenting with acute back pain, spinal mobilisation and/or manipulation is more effective than placebo in the short term and thus reduces the period of morbidity, allowing an earlier return to work.
The timing of the treatment is important. If the medical practitioner is unskilled with physical therapy, referral is appropriate. Spinal manipulation is contraindicated or ineffective in patients with acute low back pain with spasm, fixed lateral scoliosis or sciatica.
The gentler technique of mobilisation may be effective in providing relief and shortening the period of disability. Once the severe pain and spasm phase subsides (average 3-7 days), then it is usually possible to apply the more vigorous spinal manipulation technique. However, it is possible to perform manipulation safely from the outset in many patients. These are the patients who often feel that something in their back has `jammed' and feel the need for physical therapy. Such patients who have received relief, sometimes instantaneously, in the past for a similar disorder will seek out therapists who provide this treatment.
Manipulation's bad name, particularly among surgeons who have to deal with subsequent disrupted discs is related to inappropriate spinal manipulation that aggravates the problem or fails to help over a long period of time.
The management of back pain is incorrectly portrayed as a difficult problem shrouded in medical ignorance. The physician has to provide optimal circumstances for the dysfunction problem to heal itself. The key to successful management is for the practitioner to be well informed, confident and believable, and be prepared to give or organise safe effective physical therapy for back problems which are slow to respond to conservative methods."
