The role of the Back Rx exercise program in diskogenic low back pain: a prospective randomized trial

OBJECTIVE: To determine the efficacy of the Back Rx program in patients with diskogenic low back pain (LBP). DESIGN: Prospective, randomized study. SETTING: Outpatient setting of a major university teaching hospital. PARTICIPANTS: Subjects with LBP greater than leg pain for at least 3 months duration and magnetic resonance imaging evidence of disk pathology. Fifty of 87 eligible patients consented and were randomized into age- and sex-matched groups. INTERVENTIONS: Group I participated in the Back Rx program for 15 minutes a day, 3 times a week. All patients, from both groups, received celecoxib (200 mg) and hydrocodone (5 mg) with acetaminophen (500 mg) as needed, and wore a lumbar cryobrace for 15 minutes before bedtime. MAIN OUTCOME MEASURES: Roland-Morris Disability Questionnaire score, numeric pain rating score, patient satisfaction score, measured forward flexion, use of celecoxib, hydrocodone, and acetaminophen, time off work, and rate of symptom recurrence. RESULTS: At minimal 12-month follow-up, 70% of group I reported over 50% pain reduction with good or better patient satisfaction, compared with 33% in group II (P=.001). Average daily hydrocodone and acetaminophen use and time off work were less for group I (all, P<.05). Recurrence of symptoms at the end of the year was less for group I (P=.001). CONCLUSIONS: Back Rx exercises, combined with use of a lumbar cryobrace and oral medications, yielded superior therapeutic results than with use of medications and cryobrace alone. Also significant was the reduced rate of recurrence in these patients.