Everyone agrees that staying active is usually the best way to treat acute low back pain (LBP). There's still a question about the use of physiotherapy, especially the timing of treatment. United States guidelines advise early physiotherapy. Australia and Great Britain say it's best to wait and see what happens.

This study compares the two models (treat versus wait) for patients with acute LBP. Patients were tested before treatment and again six weeks, three months, and six months after treatment. The "wait group" was seen by a physiotherapist six weeks after the initial exam. Patients in the "treat group" had physiotherapy right away.

At six weeks the treat group had lower disability scores. They had fewer symptoms of depression and anxiety and a better quality of life. They also reported better social function and mental health at six weeks compared to the wait group.

Pain and disability weren't different between the groups after six months. But mood, general health, and quality of life were still much better in the treat group. The authors conclude that timing of physiotherapy does make a difference.

Early treatment for acute episodes of LBP leads to faster recovery and lower rates of disability. Advice to stay active is good, but combining it with early treatment gives better outcomes earlier.

Benedict M. Wand, BAppSc, GradDip (ExSpSc), MAppSc, PhD, et al. Early Intervention for the Management of Acute Low Back Pain: A Single-Blind Randomized Controlled Trial of Biopsychosocial Education, Manual Therapy, and Exercise. In Spine. November 1, 2004. Vol. 29. No. 21. Pp. 2350-2356.