Laurie's Blogs.


Apr 2021

The thing about low back pain studies & critical appraisal of research

I have a pet peeve!  (Well, maybe more than one.)  The PEEVE I want to discuss here is the studies and attention given to studies on non-specific low back pain.  What is non-specific low back pain?  Exactly my point!!!  There are a myriad of things that can cause chronic or non-specific low back pain:

•Facet joint irritation

•Nerve root irritation


•Muscle strain

•Disc (bulge, degeneration, extrusion…)

•Sacroiliac joint pain

•Muscle weakness


•Problematic repetitive movement patterns


•Referred pain


Why does this get me fired up?  Well, because when you read a study, whether it’s a randomized controlled trial or a systematic review, and it says that Treatment X doesn’t work for back pain, you really need to throw that study in the trash unless they have better categorized the back pain!


For example, in a list of recent studies I reviewed, I found the following:

“Among people recently recovered from LBP, exercise and education may not meaningfully reduce risk of recurrence compared to providing an educational booklet.” (Ferreira et al 2021)


“Dry cupping therapy was not superior to sham cupping for improving pain, physical function, mobility, quality of life, psychological symptoms or medication use in people with non-specific chronic low back pain.” (Silva et al 2021)


“The evidence from this systematic review is uncertain regarding the effect of therapeutic ultrasound on pain in individuals with chronic non-specific LBP (low back pain).” (Ebadi et al 2020)


“Current evidence does not support the use of PBMT (photobiomodulation therapy) to decrease pain and disability in people with non-specific LBP.” (Tomazoni et al 2020)


“While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS (return to sport) is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs (randomized controlled trials) are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.” (Thornton et al 2020)


So, what does this mean?  Nothing works???  Well, we know that THAT is false as well.  I could easily find studies that contradict these findings.  Additionally, if we then look at the systematic reviews (which are supposed to be of higher quality), they fall into the same scrutiny.  The reviews are only as good as the original papers, which are only as good as the study design, which are only as good as their patient selection criteria, and skilled application of the intervention(s)!


So, what are you to do?  You need to learn how to critically analyze the research papers. I know that I wasn’t taught how to do this in my first physiotherapy Bachelor’s degree.  I learned how to do this when I did my animal physiotherapy Master’s degree however, and I think that everyone needs to be more critical when evaluating research.


When I look at an abstract, I start with the title.  I read the Objective.  I skip down to the conclusion.  Then, if the topic seems like something I care about, I go into the methodology and results.  THAT’s where you can pick apart a research study!!  


But before I go down the rabbit hole of ‘how to analyze a research paper’, I’ll get back on topic to say, “be wary of any conclusion drawn from a research study on chronic low back pain or non-specific low back pain.”  If that is the descriptor of the study participants, then it’s already deficient!!!  Furthermore, if you want to translate the conclusions from these studies to our canine patients, you simply cannot!


Okay… rant over!  Back to being excited about the week ahead!

Cheers,  Laurie



  1. Ferreira GE, Lin CC, Stevens ML, Hancock MJ, Latimer J, Kelly P, Wisbey-Roth T, Maher CG. Exercise Is Medicine, But Perhaps Not for Preventing Low Back Pain: A Randomized Trial of Exercise and Education to Prevent Low Back Pain Recurrence. J Orthop Sports Phys Ther. 2021 Apr;51(4):188-195. 
  2. Almeida Silva HJ, Barbosa GM, Scattone Silva R, Saragiotto BT, Oliveira JMP, Pinheiro YT, Lins CAA, de Souza MC. Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial. J Physiother. 2021 Apr;67(2):132-139. 
  3. Ebadi S, Henschke N, Forogh B, Nakhostin Ansari N, van Tulder MW, Babaei-Ghazani A, Fallah E. Therapeutic ultrasound for chronic low back pain. Cochrane Database Syst Rev. 2020 Jul 5;7(7):CD009169. 
  4. Tomazoni SS, Almeida MO, Bjordal JM, Stausholm MB, Machado CDSM, Leal-Junior ECP, Costa LOP. Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review. J Physiother. 2020 Jul;66(3):155-165. 
  5. Thornton JS, Caneiro JP, Hartvigsen J, Ardern CL, Vinther A, Wilkie K, Trease L, Ackerman KE, Dane K, McDonnell SJ, Mockler D, Gissane C, Wilson F. Treating low back pain in athletes: a systematic review