Treatment of chronic low-back pain. A community-based comprehensive return-to-work physical rehabilitation program.

A retrospective evaluation of treatment methods used in 1981 and 1982 and the subsequent rate of return to work was conducted on 350 consecutive patients with low-back pain. Two hundred nine patients completed 12 or more treatments in sessions that occurred three times a week. Of these, 120 were chronically disabled. The program aimed at maximizing function and return to work through graded exercise, biomechanics education, work simulation exercises, endurance activities, and flexibility training. All patients remained under the care of their own physicians. Return-to-work or work status improvement was accomplished in 58.1% of the patients. The working hypothesis is that in many back-disabled patients the original cause of disability healed or resolved, and current symptoms were often attributable to deconditioning fear and poor biomechanics. Conservative management is effective in returning many chronic back-pain patients to economic productivity.