Researchers Identify Different Types of Back Pain Twenty years ago physical therapists treated all back pain in the same way. Now, new rules help therapists categorize a person's back pain and tailor each patient's treatment. Researchers at the University of Pittsburgh devised the diagnostic technique.
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Researchers Identify Different Types of Back Pain

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Researchers Identify Different Types of Back Pain

Researchers Identify Different Types of Back Pain

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Some physical therapists are getting better at treating back pain. It's no longer the one-size fits all approach, where everybody was told to use heat, massage, and stretching. Now, therapists have a way to evaluate a patient and predict which kind of treatment or exercise will work the fastest. NPR's Allison Aubrey reports.


Four years ago, schoolteacher Maureen Colhane was working with a bunch of elementary students, when one child jumped on her, meaning to give her a big hug.

Ms. MAUREEN COLHANE (School Teacher): I felt something go. It was just a feeling. I held back the tears until I got in the hallway, and then the counselor said, what has happened to you?

AUBREY: Colhane says she could hardly walk, and despite a doctor's prognosis that she would get better with time, her pain was relentless.

Ms. COLHANE: I had steroid injections--24 to 48 hours relief. Massages--24, 48 hours. Nothing lasted longer than that.

AUBREY: One physical therapist recommended back stretches that made the pain worse. Another therapist told her to keep trying them, that it would take time. But Colhane knew something wasn't right. So, with some research and a referral from a friend, she landed in the office of Jennifer Muller Gamboa, one of the therapists who uses the thorough spine evaluation approach to guide her treatment recommendations.

Ms. JENNIFER MULLER GAMBOA (Physical Therapist): She came in with a functional outcome score of 75 percent disability. That's huge. You know, that tells you that something is not working.

AUBREY: To figure out what, Gamboa did a vertical compression test on her new patient. Basically, this means she pushed down on Colhane's shoulders and watched to see exactly how her spine reacted.

Ms. GAMBOA: When I pushed down, if you look in the mirror, you can see, really clearly.

AUBREY: A quick buckling in the lower back.

Ms. GAMBOA: You might see it more in the rebound than you see in the actual compression.

AUBREY: The buckling suggested a hyper mobile, or loose spine, and weak abdominal muscles. And Gamboa has learned that people with these characteristics do best with a treatment approach called Core, or abdominal stabilization.

Ms. GAMBOA: That was what started me, to help me build the case of what do I needed to do with this person who's been through four years of physical therapy unsuccessfully, you know, why do I think I can make a difference?

AUBREY: Other therapists told Colhane to do generic sit-ups, but what Gamboa has done, is to teach specific exercises that target muscle groups, such as the transverse abdominals, which are key to good spine support.

Ms. GAMBOA: And it's all of those deep, postural muscles that you can't put your hands on.

AUBREY: Since most patients have no idea how to feel these deep muscles, Gamboa teaches them. In one exercise, she has Colhane lie on her back, and places an inflated blood pressure cuff under her spine. Then she moves Colhane's spine into a neutral position and tells her to tighten and hold her abdominal muscles. It's a feedback system. If Colhane does the exercise right, the needle on the blood pressure cuff won't change.

Ms. GAMBOA: You know, if one of the fastest ways to get them to be really aware of what that feels like, because it doesn't feel like, you know, a muscle burn, you know, let me do bicep curls until my muscle burns. It's not the same sensation.

AUBREY: It's much more subtle, but it's been essential to Colhane's recovery. After six weeks of this program, Colhane's disability score has improved by more than 50 percent.

Ms. COLHANE: I came here only for an evaluation.

AUBREY: Not expecting dramatic results, now she's asking herself...

Ms. COLHANE: How can this miracle be happening to me?

AUBREY: Physical therapists who use this classification approach say it's not a miracle at all--it's simply a matter of using the evidence that's come from years of clinical trials. This research has matched certain characteristics of back pain with specific interventions. Anthony Delitto of the University of Pittsburgh first outlined the idea as a graduate student, 20 years ago.

Back then, he says, everyone who complained about back pain got the same treatment: a combination of heat, massage, and stretching, but it was clear to him that the one-size-fits-all approach didn't work. Some patients got better, many didn't. So he started keeping meticulous notes, documenting patient's treatment responses, and prodding his colleagues, who were experimenting with some new techniques, to do the same.

Dr. ANTHONY DELITTO (Physical Therapy, University of Pittsburgh): I kept on hounding them and hounding them about, you know, well, what about this patient, and what about that patient? And, basically, I think I drove them crazy.

AUBREY: But it was enough to develop a rough outline of who responded best to what treatment. He and his colleagues got together with teams of researchers to study these theories, and they found some of their thinking held up.

Dr. DELITTO: Some of it didn't. And when it didn't test well, we modified things.

AUBREY: The classification system works for about 65 percent of back pain patients, Delitto estimates. The challenge, he says, is to get more physical therapists to use it.

Allison Aubrey, NPR News, Washington.

INSKEEP: Feel better? If not, well, if you have questions for the experts we interviewed, just send them to us at:, and you can also find answers to your questions from last week on back pain and surgery.

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