Q: I'm wondering about the treatment I received for low back pain this week. In the past, when my back flared up, I would see my physiotherapist and get a massage and some heat. Now that's all gone by the wayside. Everything is exercise-based. Is there any proof that one works better than the other?

A: If you are seeing a physiotherapist who is prescribing physical activity and exercises, then you are being cared for according to current guidelines. And these guidelines are based on scientific evidence gathered to date.

That doesn't mean the future rehab of low back pain won't change again. But for now, it's clear that a successful outcome depends on staying active. Physiotherapists are encouraged to use passive treatments such as heat/cold modalities, electrical stimulation, laser therapy, and so on with careful consideration and close follow-up.

Most of the time, a program of general activities and specific exercises is provided each patient on a one-to-one basis. This type of rehab program is based on the therapist's physical assessment of each individual patient.

Other factors must be considered and evaluated such as fear-avoidance behavior or pain catastrophizing. These are behavioral issues that affect how patients perceive pain and/or movement. A specific program of behavioral counseling is needed for patients who fall into either of these groups.

Julie M. Fritz, PhD, PT, ATC, et al. Physiotherapy For Acute Low Back Pain. July 15, 2008. Vol. 33. No. 16. Pp. 1800-1805.