The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion - A randomized controlled trial

Study Design. Eighteen-month, randomized controlled trial with partial cros sover. Objectives. To test the hypothesis that the control of lumbar flexion in th e early morning will significantly reduce chronic, nonspecific low back pai n. Summary of Background Data. Previous studies have indicated an increased ri sk of low back pain with bending forward in the early morning, primarily be cause of increased fluid content in the intervertebral discs at that time. Methods. After 6 months of recording baseline data, 85 subjects with persis tent or recurring low back pain were randomly assigned to treatment and con trol groups. The treatment group received instruction in the control of ear ly morning lumbar flexion. The control group received a sham treatment of s ix exercises shown to be ineffective in reducing low back pain. six months later, the control group received the experimental treatment. diaries were used to record daily levels of pain intensity, disability, impairment, and medication usage. Results. significant reductions in pain intensity (P < 0.001) were recorded for the treatment group, but not for the control group (point estimate, 33 %; 95% confidence interval, 11-55%). After receiving the experimental treat ment, the control group responded with similar reductions (P < 0.05). Signi ficant reductions also were observed in total days in pain, disability, imp airment, and medication usage. Conclusions. Controlling lumbar flexion in the early morning is a form of s elf-care with potential for reducing pain and costs associated with chronic , nonspecific low back pain.