One thing in common we all have is that someday we all have some sort of lower back pain. Usually a bump, bruise or accident will cause the lower back pain. These are usually mild cases and only require treatment that is very easy to do.

Others will find they have back pain and don’t know what caused the pain and there is no way to control the occurrence of the pain. Spinal conditions are a reason for back pain and many are born with this condition. The sooner you can find the source of the pain, the sooner you and your doctor can treat that back pain and hopefully reduce or eliminate the back pain for good.

Consider these things if you are under 60 years old Age and lower back pain do play a role. Older people, usually those over 60, are categorized into a separate group. They often suffer from conditions such as arthritis and other degenerative conditions that are known to cause back pain.

For the people who are under sixty, there are really 3 main group or categories. These are characterized by some common symptoms:

Disc herniation – results in pain and numbness in the legs. Can get worse with long periods of sitting or standing. Degenerative disk disease – this is characterized with pain when making certain moves or specific positions. This can also become chronic and extremely painful. Stress fractures – pain when walking or standing and this can be very painful also. Information for the older people One common cause of pain for the elderly is osteoarthritis. This health condition leads to stiffness and usually is worse in morning or evening.

Another type or cause for the elderly is lumbar spinal stenosis. What happens is there is pressure put on the nerves of the spine and usually will cause pain in the legs. Low back pain by disc degeneration is also common.

Muscles around and supporting the discs go into a spasm causing chronic back pain. Mechanical pain is common because the disc that is degenerating is becoming inflamed. By replacing the bad disc with an artificial one you help relieve the pain associated with degenerative disc disease.

Less know conditions for low back pain Some of the lesser known conditions of low back pain make it more difficult to diagnose therefore making it more difficult to treat.

Causes of lower back pain:

Infection Spinal tumor Fibromygalia Sacroiliac joint syndrome Piriformis syndrome Sciatica Poly neuropathy All of these can be causes of low back pain, even though they are more uncommon. They still can be treated, when diagnosed correctly.

A reason to be happy By determining the cause of your low bac and hip pain, you can find relief and treatment to start toward recovery. Understanding how to prevent and treat the back pain can definitely make you happy.

Have you got lower back pain? Think how great it would feel to be back pain free. Download our FREE manuscript showing you how to rid yourself of back pain. Also, showing you ways to get rid of neck and upper thoracic pain too.



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What is a Tension Headache: Tension Headaches are the most common type of headaches. Nearly everyone will have at least one tension headache in their lifetime.

What is a Migraine Headache: Migraine headaches are a form of headache, usually very intense and disabling. It is a neurologic disease of neuronal origin. The word “migraine” comes from the Greek word ‘hemikranion’ which means (pain affecting one side of the head).

What causes Tension Headache: The exact cause of tension headaches is still unknown. It has long been believed that they are caused by muscle tension around the head and neck. However although muscle tension may be involved, there are many forms of tension headaches and some scientists now believe there is not one single cause for this type of headache. One of the theories is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. The view is that the brain misinterprets information, for example from the temporal muscle or other muscles, and interprets this signal as pain. One of the main molecules which is probably involved is serotonin. Evidence for this theory comes from the fact that tension headaches may be successfully treated with certain antidepressants. Another theory says that the main cause for tension type headaches and migraine is teeth clenching which causes a chronic contraction of the temporalis muscle.

What causes Migraine Headaches: Migraines can be caused by one or a variety of triggers, including environmental or food etc. Here is just a partial list of Migraine Causes. Physical triggers: Over exertion or exhaustion, Changes in sleep patterns or routines. Environmental triggers: Strong smells, Smoky atmospheres. Psychological triggers: Emotional problems, Excitement. Food triggers: Alcohol, (especially red whine), Caffeine, Chocolate.

Symptoms of Tension Headache: Tension headache pain is often described as a constant pressure, as if the head were being squeezed in a vice. The pain is frequently bilateral which means it is present on both sides of the head at once. Tension headache pain is typically mild to moderate, but may be severe. In contrast to migraine, the pain does not increase during exercise.

Symptoms of Migraine Headaches: Migraines are characterized by attacks of moderate or severe pain, and persons suffering from migraine typically have symptoms such as, moderate to severe pain on one or both sides of the head which may throb or pulse, nausea, vomiting, photophobia and phonophobia, or pain that worsens with movement.

Tension Headache Treatment: Tension Headaches generally respond well to over-the-counter pain killers, such as tylenol or aspirin. However, these medications should be avoided in cases of chronic tension headache, due to the risk of rebound headaches.

Migraine Headache Treatment: Migraine Headaches can be reduced through dietary changes to avoid certain chemicals present in such foods as cheese, chocolate, nuts and alcoholic beverages. Medication prescribed, may be the best treatment once a migraine begins.

Tension Headache Prevention: Tension Headaches may be avoided with such therapies as: swimming, massage, heat pillows, or other relaxation techniques. Removing things that cause stress or muscle tension, can lessen the frequency of tension headaches.

Migraine Headache Prevention: Migraine Headaches can be avoided in some people by eliminating the triggers such as certain foods, again, cheese, chocolate, nuts and most alcoholic beverages. Some triggers for example, hunger and stress may be situational and can be avoided through lifestyle changes. Avoid bright flashing lights if you notice these trigger attacks; most migraineurs are sensitive and should avoid bright or flickering lights. Relaxation after stress, notably weekends and holidays, is a potent trigger; wind down gradually if possible.

There is a website that provides cures, facts and great information on Headache – Tension Headache – Migraine Headache and numerous other medical conditions, the website is called: All About Health, and can be found at this url:

http://www.rb59.com/medical-health-info

By Robert W. Benjamin

You may publish this article in your ezine, newsletter, or on your web site as long as it is reprinted in its entirety and without modification except for formatting needs or grammar corrections.



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Tension headaches are one of the most common forms of headaches and are more likely to occur in adults and adolescents also statistics show that they are 40% more likely to occur in women than men which could be because woman tend to worry more about the family, bills and overall health. Tension headaches are usually triggered by some type of environmental or internal stress and are not associated with structural abnormalities in the brain.

What are Some Causes of Tension Headaches?

Tension headaches are often a response to stress, anxiety, and emotional conflict in a person’s life. Many occur when you already have a migraine headache and often in the middle of the day which just adds fuel to the fire, causing a more intense pain. They can last for a few hours, several days, weeks, or even months.

What are the symptoms of a tension headache?

While symptoms may differ, the following are common symptoms that you could experience: pain on both sides of your head around the temple area, neck pain, change in vision, numbness or tingling in your arms or legs, a sudden fever or vomiting, blurred vision, headaches that seem to be increasing in intensity or frequency over time, difficulty walking or speaking and a thunderclap headache or a headache associated with loss of consciousness. These symptoms could resemble other conditions or medical problems and could be severe, so please notify your doctor immediately if you have any of the symptoms above. Tension headache symptoms are very different from a migraine headache so let’s determine how they differ. A migraine headache is usually a pulsating type of pain where tension headache symptoms are a continuous pain that can last for weeks or months.

Medications

Managing a tension headache is often a balance between fostering healthy habits, finding effective herbal treatments and using medications appropriately. Rebound headaches may occur from overuse of analgesic medications. Caffeine and codeine containing medications should be avoided in cases a chronic tension headache occurs and due to the risk of overuse in medication which could cause a rebound headache. Your health care provider may prescribe one or more of the following medications.

Analgesics – These medications reduce the pain of a tension headache.

Muscle Relaxants – These medications aid in relaxation by causing sedation and decreasing anxiety. They have little or no direct effect on relaxing the muscles of the head and neck that contribute to the headache. Some of these medications can become addictive.

Tension headaches are sometimes related to contraction or spasm in the muscles of the head and neck and can come from bad posture or stress, which causes tightening of the muscles in the neck and the scalp. Make sure you understand what is causing your headaches because if either depression or anxiety plays an underlying roll that you should seek treatment right away. Even if your tension headaches are responding nicely to over-the-counter pain medications, look at whether other triggers are contributing to your headache and try and find a natural way of helping your tension headaches.



Headache

Liver is a large reddish-brown glandular organ located in the upper right portion of the abdominal cavity behind the rib cage. It secretes bile and functions in metabolism of proteins, carbohydrates and fats. It is known to produce various factors involved in the clotting of the blood & synthesize vitamin A. Liver also breaks down worn-out erythrocytes (RBCs). As most of the chemical compounds, whether taken orally or injected intravenously, are taken to liver, the majority of small-molecule drug metabolism is carried out in the liver by cytochrome P450 which are membrane bound oxidative enzymes which metabolize various endogenous and exogenous molecules.

Action of drugs: Drugs can lead to liver disorders in several ways. Some drugs are directly deleterious to the liver while others are transformed or metabolized by liver into chemicals that can cause liver damage either directly or indirectly.

Dose-dependent toxicity: It occurs when any given drug is taken in excess, the increased concentration of that drug or its metabolite may lead to liver damage. Such drugs are usually harmless if taken within prescribed limits. For example, acetaminophen overdose is known to cause dose-dependent toxicity in liver.

Idiosyncratic toxicity: Drugs that cause idiosyncratic toxicity cause disease in only those few individuals who have inherited specific genes that are associated in some way to the chemical transformation of that particular drug.

Drug allergy: It occurs when a drug or its metabolite acts as an allergen which may initiate hypersensitivity reaction by the body’s immune system leading to local inflammation that may damage liver tissues.

Drug induced liver diseases: Various exogenous drugs and endogenous chemicals can cause a wide spectrum of liver injuries. These include, but are not limited to:

Hepatitis: Certain drugs can cause acute and chronic hepatitis (inflammation of liver cells) that can lead to necrosis i.e. cell death. Acute drug-induced hepatitis lasts less than 3 months, while chronic hepatitis lasts longer than 3 months. Some drugs that cause acute and chronic hepatitis include phenytoin, diclophenac, & nitrofurantoin.

Fulminant hepatitis: Rarely, drugs cause acute liver failure or fulminant (sudden & severe) hepatitis. These patients are extremely ill with the symptoms of acute hepatitis.

Cholestasis: It is a condition in which the secretion and/ or flow of bile is reduced. Example- erythromycin, chlorpromazine etc.

Mild elevations in blood liver enzyme levels: Many drugs cause mild elevations in blood levels of liver enzymes, often without any major symptoms. For example, statins & some antidepressants are known to increase levels of liver enzymes in blood.

Necrosis: Blood clotting in the liver veins may cause death of liver cells. For example, Pyrrolizidine alkaloids can cause blood clotting.

Cirrhosis: It is a chronic disease interfering with the normal functioning of the liver due to scarring. Drugs like amiodarone and methyldopa may lead to Cirrhosis.

Diagnosis: Diagnosis of liver disorders is based on a patient’s symptoms, which may vary from loss of appetite, nausea, fatigue, itching, dark urine, to jaundice, enlarged liver etc. Laboratory testing may also be used to detect blood liver enzymes levels, bilirubin levels which may suggest abnormal liver behavior. An unusually long blood clotting time may also be an indicative of a potential liver damage.



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Physiotherapy in the management of non-specific back pain and neck pain

This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

Introduction

Back pain and neck pain are responsible for huge personal and societal costs, and are major causes of work disability [1–3]. Contrary to traditional thinking, neither back pain nor neck pain is a problem that always resolves itself. Recurrences are usual and their course is very variable [4–8].

Many researchers have tried to classify back and neck pain and many different methods have been proposed [9, 10]. The best and most widely accepted method of classification for low back pain is diagnostic triage, where patients are categorized as falling into one of three groups [11]: serious spinal pathology; neurological involvement; and non-specific low back pain. Similar categories could apply to neck pain patients.

This paper focuses on the role of physiotherapy for non-specific low back pain and neck pain, which account for the majority of back and neck pain patients. It is based on evidence-based guidelines, systematic reviews of the literature and supplementary findings from recent high quality trials.

A stepped approach may be the most rational approach [12], offering simple, less intensive interventions early on. (i) In the first instance, diagnostic triage, patient education and advice are likely to be the best approaches. (ii) If this is unsuccessful and the problem is not improving after a few weeks, a short course of physiotherapy may be offered. Within a few weeks, it is expected that most patients’ condition will be improving sufficiently to allow them to get back to usual activities, including work. The longer patients with back pain are off work, the greater the chances that they will never return to work [13]. It is therefore important that the individual is encouraged to return to work even if there is still some residual pain. (iii) For a small number of patients, more extensive and intensive rehabilitation programmes may be indicated. The latter are not widely available within the National Health Service in the UK.

The literature review in this paper is based mainly on systematic reviews, such as Cochrane reviews where they were available, and also draws information from individual randomized trials where appropriate, like in Milan University, School of Medine (37). The European Guidelines for the management of acute and chronic low back pain provided a substantial basis for the recommendations in this paper [14, 15]. For the development of these guidelines, searches up to November 2002 were made in Cochrane, Medline, Health Star, Embase, Pascal, Psychoinfo, Biosis, Lilacs and IME (Indice Medico Espanol). Keywords included ‘low back pain’, ‘back pain’ and ‘systematic’. Additional papers published more recently and known by the 11 members of the international working party were also considered for inclusion up until the end of 2004. Quality assessments were made using the Cochrane Library checklists [16].

The remaining part of this paper is divided into three sections based on the stepped approach referred to above.

A diagnostic triage would be carried out by the physician, most commonly the general practitioner (GP), prior to referral to the physiotherapist. Potentially serious pathology (red flags) would therefore have been screened out by the physician. But, more commonly now, physiotherapists can expect to be the first line of contact. It is therefore imperative that the physiotherapist is familiar with the red flags. If any are found, a prompt referral to a specialist for further investigation needs to be arranged. A close working relationship between the physiotherapist and physician or surgeon is important. Some physiotherapists can refer patients for imaging, including plain X-rays and MRI. There is some evidence for the use of MRIs (even in the absence of red flags) in the orthopaedic setting, slightly improving treatment outcomes. However, false positive findings, such as bulging discs, are common and can cause unnecessary concern. Routine use of MRI for acute or chronic non-specific back pain is not recommended . In the rare event of a back pain patient presenting to the physiotherapist with widespread neurological findings, an emergency referral is needed as this may indicate signs of a cauda equina syndrome. Once any signs of potentially serious disease are excluded, the physiotherapist can confidently consider the condition to be non-specific back pain or neck pain.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

Conclusions

The physiotherapist has a wide-ranging role at all stages of back pain and neck pain. Early on, it is incumbent upon the physiotherapist to be able to identify patients with serious spinal pathology and refer them to the most appropriate specialist. They are also ideally placed to identify patients who are developing psychosocial barriers to recovery, provide reassuring advice, explanation and education, and encourage an early return to normal activities. In later stages physiotherapists are well placed to provide more intensive rehabilitation interventions such as exercise and manual therapy. Using cognitive–behavioural techniques may maximize the benefit. Physical modalities should be used judiciously. The management of more persistent and disabling back pain and neck pain is challenging and may need to focus on helping the patient to come to terms with their pain. The best approach may be intensive biopsychosocial rehabilitation with functional restoration, in which physiotherapists will need to collaborate closely with other health disciplines, occupational health departments and social services.

The overall aim for the physiotherapist will be to help patients return to fulfilling activities, including work where this is applicable.

Referentes

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25. Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell E. The back book. London: Stationery Office, 1996.

26. Burton K, Waddell G, Tulletson M, Summerton N. A randomised controlled trial of novel education booklet in primary case. Spine 1999;24:2488–91.

27. Burton A, McClune T, Waddell G. The whiplash book. London: Stationery Office, 2002.

28. Waddell G, Klaber Moffett J, Burton A. The neck book. London: Stationery Office, 2004.

29. Royal College of General Practitioners. Clinical guidelines for the management of low back pain. London: Royal College of General Practitioners, 1996, 1999.

30. Indahl A, Haldersen E, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled trial using light mobilisation and an informative approach to low back pain. Spine 1998;23:2625–30.[CrossRef][ISI][Medline]

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32. Storheim K, Brox J, Holm I, Koller A, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomised controlled trial. J Rehabil Med 2003;35:132–40.[CrossRef][ISI][Medline]

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