October 2025

Low Back Pain: Most Therapies Offer Minimal Benefits

In the May 2025 issue of REAL News, we covered a British Journal of Medicine report that demonstrated minimal benefits of physical (PT) or exercise (ET) therapy for those with chronic low back pain (LBP). In the September 2025 online Journal of Sports Physical Therapy, two articles rekindled concern for the benefits and value of PT or ET, even in a journal dedicated to PT. Apparently, despite patient preferences, the data still show that PT and ET only have minimal effects on pain.

One study from Australia explored factors that influence patient preferences for PT. Subjects (n=697) were given 3 PT options: home exercise, advice and education, or clinician-directed treatment. Each treatment was evaluated for “effectiveness, time for symptoms to improve, costs, risk of side effects, and treatment duration.” The results demonstrated that “Respondents preferred physical therapies with higher effectiveness, quicker symptom improvement, lower out-of-pocket expenses, reduced side effects, and shorter duration. Respondents were willing to pay up to A$355 per month for physical therapies over no treatment. Older and less-educated respondents had weaker preferences for physical therapies.” This, despite “very small” benefits.

A second study looked at the value of a program called the WalkBack Trial to see if it impacted the duration and severity of LBP patients reported a recurrence of pain. They analyzed the initial onset of pain in 596 patients and the number of days between recurrence and how much it interfered with daily activities. Walking + education yielded a shorter duration of pain recurrence than the control protocol: 3 days vs 4 days. The walkers reported lower pain intensity.

Overall, the results of these two studies show “the benefits (of PT) were small and of uncertain clinical relevance.”

HIIT for Brawn and Brain

As the Boomers age, with the Gen X and Millenials right behind, physical and cognitive health are first and foremost in the minds of many. The Harvard Men’s Health Watch newsletter (Oct. 2024) reported on a study in Aging and Disease journal (July 2024) that found high intensity interval training (HIIT) may be better for brain – and body – health than milder forms. HIIT consists of repeated bouts of high-intensity exercise followed by recovery periods of lower intensity.

The study enrolled 151 healthy older adults (65-86 yrs old) in a 6-month program to do one of three half-hour exercise sessions: balance & stretching (Light), brisk treadmill walking (Medium), or 4 cycles of 4 minutes of very fast walking followed by 3 minutes of recovery on a treadmill (HIIT). All participants underwent a series of tests to assess function of the hippocampus, the part of the brain associated with learning and memory.

Upon completion of the program of 72 workouts, only the HIIT group “showed positive changes in the hippocampus functioning compared to their initial evaluation.”

Even after 5 years, when all of them were re-evaluated, the researchers found that “again only the people in the HIIT group retained their improved cognitive function” even if they’d stopped exercising at such high intensities.

Measures such as paired associative learning, MRI volumetric images of several cortical regions, “functional connectivity between multiple neural networks”, and brain-derived neurotrophic factor (BDNF: a protein that supports neuron growth and function) improved in the HIIT group only.

As the authors noted, “Sustained improvement in hippocampal function to this extent confirms that such exercise-based interventions can provide significant protection against hippocampal cognitive decline in the aged population.”

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