Physical therapy provides modest improvements for chronic low back pain: Study

A sequential, multiple assignment, randomized trial (SMART) found that people with chronic low back pain experienced slight improvement in daily function when starting treatment with physical therapy compared with cognitive behavioral therapy. While long-term pain relief was similar across different treatment approaches, small differences between the groups support physical therapy as a first-line treatment strategy consistent with practice guidelines for chronic low back pain.

The study is published in Annals of Internal Medicine.

Researchers from the University of Utah and colleagues conducted the OPTIMIZE (Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back) trial to compare the effectiveness of common nonpharmacologic treatments for persons with chronic low back pain and examine what works best when initial treatment does not help.

They followed 749 adults across three health systems between March 2019 and September 2023 who were randomly assigned to eight weeks of either physical therapy or cognitive behavioral therapy. Those who did not improve were reassigned to a second treatment, either switching therapies or trying mindfulness-based care.

After 10 weeks, participants who started with physical therapy showed a small improvement in function, though pain levels were similar between groups. After one year, no meaningful differences were seen among second-stage treatments.

The findings suggest physical therapy may be a reasonable first option for chronic low back pain, but switching or adding other therapies later may not change long-term outcomes.

Reference:

Julie M. Fritz, Richard L. Skolasky, Gerard Brennan, et al. Effectiveness of Nonpharmacologic Treatments for Chronic Low Back Pain: A Sequential, Multiple-Assignment, Randomized Trial. Ann Intern Med. [Epub 21 April 2026]. doi:10.7326/ANNALS-25-04645