Researchers around the world are trying different forms and combinations of exercise and other treatment approaches to solve the problem of chronic low back pain (CLBP). This study was done in the Netherlands by a group of psychologists and rehab specialists.

They divided adults with CLBP into four groups. Each group received a different treatment. Group one had 10 weeks of aerobic training along with strengthening of the back extensor muscles. This was called active physical treatment (APT).

Group two had 10 weeks of physical activities and problem solving training (PST). The physical activities were geared to the patient and slowly increased over time. Problem solving was designed to help patients find ways to do more despite their pain. This treatment was called graded activity plus problem solving or GAP.

Group three had both APT and GAP. This was referred to as combination treatment (CT). A physiotherapist supervised patients in the first three groups. A psychologist or social worker provided the PST. Patients in group four (control group) were on a waiting list for services. They received no treatment during this 10-week period of time.

The results showed that combining treatments didn't work any better than single treatment approaches. Patients were tested at six and 12 months after treatment. Levels of pain, depression, and levels of disability were not different among the treatment groups.

The authors could not account for these results. They offered suggestions for future studies. For example, there may be subgroups of patients identified by certain characteristics who would benefit the most from one specific form of treatment. Or perhaps treatment could be more fine-tuned for certain types of problems.

Treatment for CLBP is often focused on improving strength and aerobic capacity. The goal is to restore functional abilities and allow patient to resume normal activities. Experts agree that combining several treatment modes works better than doing nothing. This study has added to our knowledge of what works and what doesn't.

Rob J. E. M. Smeets, et al. Chronic Low Back Pain: Physical Training, Graded Activity With Problem Solving Training, or Both? The One-Year Post-Treatment Results of a Randomized Controlled Trial. In Pain. February 2008. Vol. 134. No. 3. Pp. 263-276.