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I went on-line to find a physical therapist who specializes in low back pain. I live in a big city but was still surprised to find so many therapists who advertise their expertise in this area. The only problem is -- when I compared each website, I found six different treatment methods available. How do I know which one to go to?

That's a good question and one we may not have an exact answer for. But here's some information that might guide you. There are two things we know for sure about low back pain: 1) there is no known cause for the majority of people who experience this problem and 2) there's no magic treatment that works for everyone. Despite this knowledge, physical therapists have not been scared away from trying to find effective ways to help people manage this condition. We know that exercise as a form of therapy helps many patients in terms of pain reduction and improved function. With that in mind, the next step is to find out which specific exercise program works best. Research toward this goal has led to the development of a concept called patient classification. Patient classification divides people into groups of people who have similar characteristics. This creates more of a homogeneous (similar) group, which is easier to study and provides more reliable data. Patient classification has then resulted in clinical prediction rules (CPRs). CPRs are guidelines to help therapists identify and recognize factors that predict a response or nonresponse to treatment. Clinical prediction rules (CPRs) are helping physical therapists find ways to identify which patients would likely respond best to individual treatment approaches. It sounds like you have found therapists who have some specific training in one of the many treatment methods out there. Perhaps you saw something about spinal manipulation or lumbar stabilization exercises. There's also the McKenzie technique (direction-specific exercises), muscle retraining, and Pilates exercise. Therapists are trained to evaluate all patients and consider whether there are reasons to use one approach over another. Even though they may advertise a specific type of method, if you don't respond to that treatment (or the therapist can tell from the start that you need something else), then you will be treated accordingly or referred elsewhere. The best approach may be a quick telephone interview with each clinic you have found. Let them know your situation and ask how their program might benefit you. You can also make a brief appointment to meet the therapist directly and ask a few questions that might help you find the right match for you. Like many people with back pain, it may take a period of trial and error to find the right treatment or combinations of approaches that works best for you. Don't give up!

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