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Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled
John M Mayer1, Lee Ralph, Michele Look
1U.S. Spine & Sport Foundation, 344 Kearny Villa Road, Suite 307, San Diego, CA 92123, USA. jmayer2@san.rr.com
Background Context:
Restorative exercise and palliative modalities are frequently used together for the treatment of acute low back pain. However, little is known about the effects of combining these treatments.
Purpose:
To evaluate the efficacy of combining continuous low-level heat wrap therapy with directional preference-based exercise on the functional ability of patients with acute low back pain.
Study Design/Setting:
A randomized controlled trial was conducted at three outpatient medical facilities.
Patient Sample:
One hundred individuals (age 31.2+/-10.6 years) with low back pain of less than 3 months duration.
Outcome Measures:
The primary outcome measure was functional ability assessed by the Multidimensional Task Ability Profile questionnaire. Secondary outcomes were disability assessed by the Roland-Morris Disability Questionnaire and pain relief assessed by a 6-point verbal rating scale.
Methods:
Participants were randomized to one of four groups: Heat wrap therapy alone (heat wrap, n=25); directional preference-based exercise alone (exercise, n=25); combination of heat wrap therapy and exercise (heat+exercise, n=24); or control (booklet, n=26). Treatment was administered for five consecutive days and included four visits to the study center over 1 week.
Results:
At 2 days after the conclusion of treatment (Day 7), functional improvement for heat+exercise was 84%, 95%, and 175% greater than heat wrap, exercise, and booklet, respectively (p<.05). Seventy-two percent of the subjects in the heat+exercise group demonstrated a return to pre-injury function compared with 20%, 20%, and 19% for heat wrap, exercise, and booklet, respectively (p<.05). Disability reduction for heat+exercise was 93%, 139%, and 400% greater than heat wrap, exercise, and booklet, respectively (p<.05). Pain relief for heat+exercise was 70% and 143% greater than exercise and booklet, respectively (p<.05).
Conclusions:
Combining continuous low-level heat wrap therapy with directional preference-based exercise during the treatment of acute low back pain significantly improves functional outcomes compared with either intervention alone or control. Either intervention alone tends to be more effective than control.