Patients with mechanical low back pain (LBP) of unknown cause are often lumped together. Everyone gets the same treatment. But a group of physiotherapists suggest that patients with nonspecific LBP should be treated individually. Subgrouping patients during treatment gives better results.

They proved this by randomly dividing 123 LBP patients into three treatment groups. The groups included manipulation, specific exercise, or stabilization. Everyone was seen by a physiotherapist twice a week for four weeks.

Patients who did well and improved moved on to Stage II treatment. The Stage II program included aerobic exercise on a treadmill or bike. Strengthening and flexibility exercises were also added.

Results were measured and compared to a previous group of patients whose signs and symptoms were used to decide which treatment was best. All patients were followed for one year after finishing the treatment program.

The authors conclude that classifying LBP patients into subgroups for treatment can be done based on signs and symptoms. Results are better than when patients are all treated the same without subgrouping. Chronic LBP and long-term disability may be avoided when patients are treated specifically because they recover quickly.

Gerard P. Brennan, PhD, PT, et al. Identifying Subgroups of Patients with Acute/Subacute "Nonspecific" Low Back Pain. In Spine. March 15, 2006. Vol. 31. No. 6. Pp. 623-631.