For years, scientists have tried to figure out what treatment works best for patients with low back pain (LBP). Physiotherapists have joined that effort by studying various types of exercises that might help.

In this study, the results of two types of exercises are compared in similar kinds of patients. Group one received the extension-oriented treatment approach (EOTA). Group two followed a strengthening exercise program.

The important difference in this study was the fact that all patients with LBP were part of a subgroup. Each one tested positive for the presence of centralization. Centralization means that pain in the buttock or leg went away or moved up closer to the midline of the lumbar spine. This response occurred during extension movement testing.

The new idea in back pain research is to identify LBP patients who are likely to respond to a particular type of exercise program. Matching patients this way will help create a system of treatment based on classification.

Patients in both groups saw a physiotherapist a total of six sessions during a 30-day period. The type of extension and strengthening exercises for each group were described. Everyone was given a home program to carry out on the days they didn't come to therapy.

Patients were re-examined after one and four weeks. A survey of questions was sent to each one at the end of six months. The results showed that patients in the EOTA group had less pain at the end of the first week compared to the strengthening group. No other differences were observed between the two groups throughout the rest of the study.

Treating all LBP patients alike may be why no specific treatment has been found to help the majority of the group. Efforts to match treatment to subgroups of LBP patients are ongoing.

Finding subgroups of LBP patients most likely to benefit from exercise is a start. The results of this study suggest the need to narrow the groups even more. Further study is needed to identify LBP who can benefit the most from EOTA.

David A. Browder, MAJ, PT, DPT, OCS et al. Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects with Low Back Pain: A Randomized Clinical Trial. In Physiotherapy. December 2007. Vol. 87. No. 12. Pp. 1608-1618.