THE EFFECT OF A SINGLE TREATMENT OF HEAT AND EXERCISE ON PAIN AND PERFORMANCE IN PATIENTS WITH LOW BACK PROBLEMS

Patients with low back pain (LBP) are often referred for physical therapy (PT). PT usually includes general and specific exercises, and may include a modality such as topical heat. Neither individual nor combination interventions have been adequately tested in clinical trials. PURPOSE: This controlled trial tested the effect of a single treatment of heat and exercise, alone and in combination, on pain and performance, in subjects with LBP. SUBJECTS: Sixty subjects (23 males and 37 females) with nonspecific LBP participated. METHODS: Subjects were randomly assigned to one of four intervention groups; heat, exercise, heat and exercise, or a control group. Subjects in the heat group reclined with a heating pad. Subjects in the exercise group walked for 20 minutes and then performed a variety of stretching exercises. Subjects in the heat and exercise group, had heat applied for one hour, and then walked and exercised with the heating pad in situ. The control group received information about back pain. Pain was assessed before and immediately after the intervention using numerical rating scales for pain intensity and pain affect. Performance was assessed pre- and post-intervention using a performance battery (a series of tasks in which time taken or distance reached or walked is measured) (Simmonds et al, 1998). RESULTS: Key results were as follows. Multiple analyses of covariance (MANCOVA) were significant for group, on pain and performance measures (p [is less than] .05). Univariate ancova revealed a significant treatment effect on pain intensity and affect and timed sit-to-stand. Post hoc Tukey tests revealed differences between the control group and each of the treatment groups. Heat and exercise caused the greatest reduction in pain intensity and heat alone caused the greatest reduction in pain effect. The magnitude of change in performance was task specific and appeared to be mediated by pre-test pain level as well as group assignment. CONCLUSION: In conclusion, a single treatment of heat and exercise alone, and in combination, was effective in reducing pain. Further research is necessary to determine the effectiveness of a series of treatments, and the optimal dose and timing of such treatments. Simmonds et al, Spine 23:1998, 2412-2421.
Simmonds MJ, Weingand K(*), Lee CE, Vongsirinavarat M, Jones S(#) School of Physical Therapy, Texas Woman's University, Houston, TX; (*) Proctor and Gamble Co, Mason, OH; (#) Spine Care South [...]