Evaluation is treatment for low back pain

J Man Manip Ther. 2021 Feb;29(1):4-13. doi: 10.1080/10669817.2020.1730056. Epub 2020 Feb 24.


Objective: To investigate the effect of the examination process (history taking and physical examination) on pain and function. Methods: An observational cohort trial of patients presenting to outpatient physical therapy clinics for the first time with low back pain (n = 34, 57.7 ± 18.7 years, 53% female). A blinded investigator measured participants prior to the beginning of the initial evaluation and after each component of evaluation (history taking and physical examination). Another physical therapist provided normal history taking and physical examination as the patient case presented itself. Primary outcome measure was numeric pain rating scale (NPRS) for the low back and leg. Secondary outcomes and time during examination process and connection between PT and patient were also measured as potential confounders. Results: Participants showed a significant reduction in pain through just the history taking and physical exam for both the back with an NPRS reduction of 1.23 and the leg showing a 0.95 NPRS reduction. The most significant reduction occurs after history taking. Discussion: The evaluation process produced small, but significant, therapeutic effects related to pain, fear-avoidance, pain catastrophization, and functional measures of mobility and sensitivity. The therapist's report of connection with the patient did not alter the patient outcome.

Keywords: Physical examination; medical history taking; musculoskeletal pain; physical therapy.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Low Back Pain / therapy*
  • Male
  • Medical History Taking*
  • Middle Aged
  • Pain Measurement
  • Physical Examination*
  • Surveys and Questionnaires

Grants and funding

The authors affirm that they have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript.